Provider Demographics
NPI:1700872140
Name:RATCLIFF, ROBERT CRAIG (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CRAIG
Last Name:RATCLIFF
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 1:419 S WASHINGTON ST
Mailing Address - Street 2:SUITE102
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2951
Mailing Address - Country:US
Mailing Address - Phone:307-577-4220
Mailing Address - Fax:307-235-0931
Practice Address - Street 1:214 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:KREMMLING
Practice Address - State:CO
Practice Address - Zip Code:80459-0399
Practice Address - Country:US
Practice Address - Phone:970-887-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4228A208600000X, 208C00000X
CO56354208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312911OtherBLUE CROSS BLUE SHIELD
WY107011800Medicaid
WYA73086Medicare UPIN