Provider Demographics
NPI:1942820964
Name:RATLIFF, ELLEN FOSTER (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:FOSTER
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ELIZABETH
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2225 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2198
Mailing Address - Country:US
Mailing Address - Phone:318-221-2225
Mailing Address - Fax:318-459-2955
Practice Address - Street 1:2225 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2198
Practice Address - Country:US
Practice Address - Phone:318-221-2225
Practice Address - Fax:318-459-2955
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA334498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics