Provider Demographics
NPI:1477640357
Name:RATCLIFF, DANIEL JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JONATHAN
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 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-380-4050
Mailing Address - Fax:512-380-4092
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-380-4050
Practice Address - Fax:512-380-4092
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0093207Y00000X
TXK2989207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189307501Medicaid
TXH89335Medicare UPIN
TX8F871Medicare PIN