Provider Demographics
NPI:1285021287
Name:RAYMOND WESTBROOK DO PA
Entity type:Organization
Organization Name:RAYMOND WESTBROOK DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYLES
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-356-3110
Mailing Address - Street 1:2701 MATLOCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2529
Mailing Address - Country:US
Mailing Address - Phone:817-786-3040
Mailing Address - Fax:817-786-3041
Practice Address - Street 1:2701 MATLOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2529
Practice Address - Country:US
Practice Address - Phone:817-786-3040
Practice Address - Fax:817-786-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045797005Medicaid
TX045797003Medicaid
TX045797004Medicaid