Provider Demographics
NPI:1205886090
Name:RATCLIFF, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0550
Mailing Address - Country:US
Mailing Address - Phone:479-463-7775
Mailing Address - Fax:479-463-7187
Practice Address - Street 1:3 EAST APPLEBY ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-404-1200
Practice Address - Fax:479-463-1201
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8080207R00000X
ARN-8080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54545OtherBLUE
AR119018001Medicaid
AR54545Medicare ID - Type Unspecified
AR119018001Medicaid