Provider Demographics
NPI:1871597385
Name:RATLIFF, DONALD W (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-0190
Mailing Address - Country:US
Mailing Address - Phone:662-454-3401
Mailing Address - Fax:662-454-7278
Practice Address - Street 1:102 THIRD ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827-0190
Practice Address - Country:US
Practice Address - Phone:662-454-3401
Practice Address - Fax:662-454-3401
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7354207Q00000X
AL8253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016909Medicaid
MS082945519OtherMEDICARE PROVIDER NUMBER
MSC00480Medicare PIN
MS00016909Medicaid