Provider Demographics
NPI:1942287248
Name:RACZ, TIBOR ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBOR
Middle Name:ANTHONY
Last Name:RACZ
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 1:17051 DALLAS PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7114
Mailing Address - Country:US
Mailing Address - Phone:972-433-9720
Mailing Address - Fax:972-433-9721
Practice Address - Street 1:17051 DALLAS PKWY STE 440
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7114
Practice Address - Country:US
Practice Address - Phone:972-433-9720
Practice Address - Fax:972-433-9721
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4458207L00000X, 207LP2900X, 2084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029801003Medicaid
TXP00197300OtherRR MEDICARE
TX8M8934OtherBCBS
TX029801002Medicaid
TX8M8934OtherBCBS
TX8C9488Medicare PIN
TX029801002Medicaid