Provider Demographics
NPI:1942299797
Name:JEFFREY P RATTET MD INC
Entity Type:Organization
Organization Name:JEFFREY P RATTET MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RATTET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-6904
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-1037
Mailing Address - Country:US
Mailing Address - Phone:909-337-1120
Mailing Address - Fax:
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:#524
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-886-6904
Practice Address - Fax:909-881-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32586207N00000X
IN01053564A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325860Medicaid
A45205Medicare UPIN
ZZZ23058ZMedicare ID - Type Unspecified