Provider Demographics
NPI:1104030782
Name:RATINO, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:RATINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-6015
Practice Address - Street 1:1307 8TH AVE.,
Practice Address - Street 2:SUITE 506
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4142
Practice Address - Country:US
Practice Address - Phone:817-332-6092
Practice Address - Fax:817-332-6015
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7558208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00408195OtherRR MEDICARE
TX186710301Medicaid