Provider Demographics
NPI:1558440750
Name:RATTAN, RAIFORD ADRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAIFORD
Middle Name:ADRIAN
Last Name:RATTAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270504
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-0504
Mailing Address - Country:US
Mailing Address - Phone:972-874-0116
Mailing Address - Fax:972-874-0206
Practice Address - Street 1:2716 COCKRELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1119
Practice Address - Country:US
Practice Address - Phone:214-724-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1553213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU86933Medicare UPIN
TX00339PMedicare ID - Type Unspecified