Provider Demographics
NPI:1871595124
Name:RACZ, GABOR BELA (MD)
Entity type:Individual
Prefix:
First Name:GABOR
Middle Name:BELA
Last Name:RACZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 N LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1410
Mailing Address - Country:US
Mailing Address - Phone:806-744-7223
Mailing Address - Fax:806-740-3325
Practice Address - Street 1:4515 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2520
Practice Address - Country:US
Practice Address - Phone:806-744-7223
Practice Address - Fax:806-740-3325
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9343207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100013830AMedicaid
NMV3942Medicaid
NM201021596OtherPRESBYTERIAN COMERCIAL
A003OtherTRIWEST
TX89C482OtherBC/BS
TX121968100OtherFIRSTCARE COMMERCIAL
TX129835804Medicaid
TX121968101Medicaid
TX129835801Medicaid
NM201021596Medicaid
TX80764ZOtherHMO BLUE
A003OtherTRIWEST
TXB79898Medicare UPIN
TX121968101Medicaid