Provider Demographics
NPI:1013910082
Name:RABORN, WESTLEY EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:WESTLEY
Middle Name:EUGENE
Last Name:RABORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1184
Mailing Address - Country:US
Mailing Address - Phone:214-660-2500
Mailing Address - Fax:214-660-2535
Practice Address - Street 1:2704 N GALLOWAY AVE
Practice Address - Street 2:STE 103
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6378
Practice Address - Country:US
Practice Address - Phone:214-660-2500
Practice Address - Fax:214-660-2535
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130858708Medicaid
TXD97648Medicare UPIN
TXTXB110499Medicare PIN