Provider Demographics
NPI:1720410582
Name:DUSTIN RABER MD INC
Entity Type:Organization
Organization Name:DUSTIN RABER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-639-7602
Mailing Address - Street 1:449 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4384
Mailing Address - Country:US
Mailing Address - Phone:559-639-7602
Mailing Address - Fax:
Practice Address - Street 1:810 E D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9545
Practice Address - Country:US
Practice Address - Phone:559-639-7602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR9718529OtherDEA