Healthcare Provider Details

I. General information

NPI: 1184085227
Provider Name (Legal Business Name): DOMINIC SAMUEL RATTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date: 07/27/2020
Reactivation Date: 07/30/2020

III. Provider practice location address

3551 ROGER BROOKE DR
JBSA FT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5545
  • Fax:
Mailing address:
  • Phone: 253-968-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU5497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: