Provider Demographics
NPI:1124219449
Name:DABNEY, RAETASHA SHEAVETTE (MD)
Entity Type:Individual
Prefix:
First Name:RAETASHA
Middle Name:SHEAVETTE
Last Name:DABNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 LAS COLINAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7569
Mailing Address - Country:US
Mailing Address - Phone:214-379-2722
Mailing Address - Fax:972-869-3875
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 470
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4415
Practice Address - Country:US
Practice Address - Phone:214-379-2700
Practice Address - Fax:972-869-3875
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3593207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124219449Medicaid
TX35439802Medicaid