MEDICARE: DR. WESTLEY EUGENE RABORN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E2326	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013910082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESTLEY EUGENE RABORN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 741184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-1184
Country	:	US
Telephone Number	:	214-660-2500
Fax Number	:	214-660-2535

Provider Business Practice Location Address
First Line	:	2704 N GALLOWAY AVE
Second Line	:	STE 103
City	:	MESQUITE
State	:	TX
Zip	:	75150-6378
Country	:	US
Telephone Number	:	214-660-2500
Fax Number	:	214-660-2535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/31/2011

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