Provider Demographics
NPI:1881216307
Name:RATCLIFF, ADAM DILLON (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DILLON
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 1:4450 TROPEA WAY UNIT 1215
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8798
Mailing Address - Country:US
Mailing Address - Phone:479-445-4464
Mailing Address - Fax:
Practice Address - Street 1:ANDERSEN AIR FORCE BASE
Practice Address - Street 2:UNIT 14010
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96543-4003
Practice Address - Country:US
Practice Address - Phone:671-366-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GU0101273151208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program