Basic Information
| Provider Information | |||||||||
| NPI: | 1124219449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DABNEY | ||||||||
| FirstName: | RAETASHA | ||||||||
| MiddleName: | SHEAVETTE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7415 LAS COLINAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750637569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143792722 | ||||||||
| FaxNumber: | 9728693875 | ||||||||
| Practice Location | |||||||||
| Address1: | 431 E STATE HIGHWAY 114 STE 470 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760924415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143792700 | ||||||||
| FaxNumber: | 9728693875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 04/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N3593 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1124219449 | 05 | TX | MEDICAID | 35439802 | 05 | TX | MEDICAID |