Provider Demographics
NPI:1043272735
Name:DANCHAK, RAYMOND MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:DANCHAK
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 93882
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-3882
Mailing Address - Country:US
Mailing Address - Phone:806-785-8000
Mailing Address - Fax:806-792-7174
Practice Address - Street 1:4601 50TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3513
Practice Address - Country:US
Practice Address - Phone:806-785-8000
Practice Address - Fax:806-792-7174
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80K294Medicare ID - Type Unspecified
TX00F26YMedicare ID - Type UnspecifiedMEDICARE GROUP #
TXE41505Medicare UPIN