Provider Demographics
NPI:1588603112
Name:RATZER, JOHN W (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:RATZER
Suffix:
Gender:M
Credentials:CRNA
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 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:1106 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-568-2000
Practice Address - Fax:740-568-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.03487.NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000590690OtherANTHEM
OH000000641591OtherANTHEM
OHP00815809OtherRRMCR
OH0787046Medicaid
OH2604111000Medicaid
OH000000641591OtherANTHEM
OH8207173Medicare PIN
OH0787046Medicaid