Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G7314 | TX |
NPI | 1063476224 |
---|---|
Provider Name | Ian Mark Ratner |
First Address | Richardson, TX 75082-3542 |
Second Address | Richardson, TX 75082-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19535 | (02) | TX |
G7314 | LICENSE (01) | TX |