Provider Demographics
NPI:1164512117
Name:RASBERRY, JOHN LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:RASBERRY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:11211 N COUNTY ROAD 1500
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-3019
Mailing Address - Country:US
Mailing Address - Phone:806-832-1832
Mailing Address - Fax:806-832-0918
Practice Address - Street 1:8602 PEACH AVE
Practice Address - Street 2:TTHSC/TDCJ/JOHN T. MONTFORD MEDICAL/PSYCH UNIT
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-7777
Practice Address - Country:US
Practice Address - Phone:806-745-1021
Practice Address - Fax:806-745-7554
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
TXPA00720363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10134754OtherDEA REGISTRATION NUMBER