Provider Demographics
NPI:1609458850
Name:RATLIFF, TABETHA S (MD)
Entity type:Individual
Prefix:
First Name:TABETHA
Middle Name:S
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3737
Mailing Address - Country:US
Mailing Address - Phone:541-768-4906
Mailing Address - Fax:
Practice Address - Street 1:3002 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3627
Practice Address - Country:US
Practice Address - Phone:509-444-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61535779207Q00000X
ORPG205095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine