Provider Demographics
NPI:1194760074
Name:DABELIC, RACHAEL KENDRA (MD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:KENDRA
Last Name:DABELIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3914 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2908
Mailing Address - Country:US
Mailing Address - Phone:817-238-0109
Mailing Address - Fax:817-238-0647
Practice Address - Street 1:3914 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2908
Practice Address - Country:US
Practice Address - Phone:817-238-0109
Practice Address - Fax:817-238-0647
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176578601Medicaid
TX8U6830OtherBCBS
TX176578603Medicaid
TX176578601Medicaid