Healthcare Provider Details

I. General information

NPI: 1063476224
Provider Name (Legal Business Name): IAN MARK RATNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

3001 E PRESIDENT GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-6663
  • Fax: 214-343-2814
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG7314
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG7314
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: