Provider Demographics
NPI:1871504795
Name:SANCHEZ, RAFAEL G (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:G
Last Name:SANCHEZ
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 1:6250 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5262
Mailing Address - Country:US
Mailing Address - Phone:325-428-5500
Mailing Address - Fax:325-428-5519
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1010
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-428-5500
Practice Address - Fax:325-428-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9383174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034247901Medicaid
TN00JR12OtherBCBS PROVIDER #
TX034247901Medicaid
TXD67717Medicare UPIN