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General NPI Number Information
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NPI Number | 1164512117
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Entity Type | Individual
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Provider Name | JOHN LEE RASBERRY PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 8602 PEACH AVE TTHSC/TDCJ/JOHN T. MONTFORD MEDICAL/PSYCH UNIT
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City | LUBBOCK
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State | TX
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Zip | 79404-7777
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Country | US
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Telephone | 806-745-1021
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Fax | 806-745-7554
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Provider Business Mailing Address
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Address Line | 11211 N COUNTY ROAD 1500
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City | SHALLOWATER
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State | TX
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Zip | 79363-3019
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Country | US
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Telephone | 806-832-1832
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Fax | 806-832-0918
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00720
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License Number State | TX
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