Provider Demographics
NPI:1245337344
Name:RATLEY, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RATLEY
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83628207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2443808OtherUNITED HEALTHCARE
CA7208632OtherAETNA
CA00A836280OtherBLUE SHIELD
CA00A836280Medicaid
CAMCMG343700OtherWESTERN HEALTH ADVANTAGE
CA236150OtherHEALTH NET
CA7071951OtherCIGNA
CA000810607467OtherPHCS
CAA83628OtherBLUE CROSS
CA1806848OtherGREAT WEST
CA2237972OtherFIRST HEALTH
CA90141472OtherINTERPLAN
CA7208632OtherAETNA
CA00A836280Medicare ID - Type Unspecified