Healthcare Provider Details

I. General information

NPI: 1881829901
Provider Name (Legal Business Name): JEANINE LOUISE DAVIS RATLIFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3001 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 TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP6706
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP6706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: