Provider Demographics
NPI:1346271913
Name:RABORN, SAMUEL W (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:RABORN
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 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:125 HWY 31 EAST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758
Practice Address - Country:US
Practice Address - Phone:903-849-3862
Practice Address - Fax:903-849-4965
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13142Medicare UPIN
TX8272N5Medicare PIN