Provider Demographics
NPI:1174853675
Name:WESTLEY E. RABORN D.O., P.A.
Entity Type:Organization
Organization Name:WESTLEY E. RABORN D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESTLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-329-6160
Mailing Address - Street 1:PO BOX 851347
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1347
Mailing Address - Country:US
Mailing Address - Phone:972-329-6160
Mailing Address - Fax:972-289-0177
Practice Address - Street 1:1336 N GALLOWAY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7417
Practice Address - Country:US
Practice Address - Phone:972-329-6160
Practice Address - Fax:972-289-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2326208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97648Medicare UPIN