MEDICARE: DR. RAEANN GRAYBILL CAPEHART M.D.

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	208600000X	Surgery Physician	G9437	TX

General Provider Information

NPI Number	:	1629031547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAEANN GRAYBILL CAPEHART M.D.

Provider Business Mailing Address
First Line	:	1151 N BUCKNER BLVD
Second Line	:	SUITE 105
City	:	DALLAS
State	:	TX
Zip	:	75218-3403
Country	:	US
Telephone Number	:	214-321-3536
Fax Number	:	214-321-3520

Provider Business Practice Location Address
First Line	:	1151 N BUCKNER BLVD
Second Line	:	SUITE 105
City	:	DALLAS
State	:	TX
Zip	:	75218-3426
Country	:	US
Telephone Number	:	214-321-3536
Fax Number	:	214-321-3520

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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