Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 008041 | AZ |
NPI | 1306227780 |
---|---|
Provider Name | Tim Michael Ratliff |
First Address | Glendale, AZ 85308-7114 |
Second Address | Glendale, AZ 85308-7114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 08/10/2019 |