Provider Demographics
NPI:1063449692
Name:RATCLIFF, JOHN BAXTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BAXTER
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-863-8444
Mailing Address - Fax:870-863-7540
Practice Address - Street 1:706 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-863-8444
Practice Address - Fax:870-863-7540
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3243207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106171001Medicaid
160052555OtherPALMETTO GBA
720980896OtherUNITED HEALTH CARE
AR13291000000OtherQUALCHOICE
160052555OtherPALMETTO GBA
ARD39091Medicare UPIN