Provider Demographics
NPI:1992897763
Name:DOMINIC L RACO MD PA
Entity type:Organization
Organization Name:DOMINIC L RACO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-540-7788
Mailing Address - Street 1:4510 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1650
Mailing Address - Country:US
Mailing Address - Phone:972-540-7788
Mailing Address - Fax:972-540-7787
Practice Address - Street 1:4510 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 313
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:972-540-7788
Practice Address - Fax:972-540-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069NVOtherBCBS
TX0069NVOtherBCBS
TXG12522Medicare UPIN