Provider Demographics
NPI:1760454771
Name:RACSA, NEMESIO A (MD)
Entity type:Individual
Prefix:DR
First Name:NEMESIO
Middle Name:A
Last Name:RACSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:527 W PARK ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5265
Mailing Address - Country:US
Mailing Address - Phone:509-547-0503
Mailing Address - Fax:509-547-5815
Practice Address - Street 1:527 W PARK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5265
Practice Address - Country:US
Practice Address - Phone:509-547-0503
Practice Address - Fax:509-547-5815
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00014929207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1006642Medicaid
WA0203657OtherL&I NUMBER
WAA15221Medicare UPIN
WA0301290Medicare ID - Type Unspecified