1124219449 NPI number — RAETASHA SHEAVETTE DABNEY M.D.

Table of content: TERRAN HARCOURT DAILY OTR L (NPI 1801962352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124219449 NPI number — RAETASHA SHEAVETTE DABNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DABNEY
Provider First Name:
RAETASHA
Provider Middle Name:
SHEAVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124219449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7415 LAS COLINAS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-379-2722
Provider Business Mailing Address Fax Number:
972-869-3875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 E STATE HIGHWAY 114 STE 470
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-379-2700
Provider Business Practice Location Address Fax Number:
972-869-3875
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  N3593 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1124219449 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35439802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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