=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033559208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK RATLIFF DVM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2013
-----------------------------------------------------
Last Update Date | 07/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 RHUBENS BR
-----------------------------------------------------
City | LOUISA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41230-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-673-1144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 RHUBENS BR
-----------------------------------------------------
City | LOUISA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41230-6714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174M00000X
-----------------------------------------------------
Taxonomy Name | Veterinarian
-----------------------------------------------------
License Number | 2883
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------