Provider Demographics
NPI:1508951658
Name:E. CRAIG RABY MD PA
Entity Type:Organization
Organization Name:E. CRAIG RABY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:RABY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-328-5746
Mailing Address - Street 1:310 S PALM AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4179
Mailing Address - Country:US
Mailing Address - Phone:386-328-5746
Mailing Address - Fax:
Practice Address - Street 1:310 S PALM AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4179
Practice Address - Country:US
Practice Address - Phone:386-328-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 18390207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty