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NPI Code Detail

MEDICARE: DR. RAYMOND HOWARD DURUSSEL D.P.M.

MEDICARE: DR. RAYMOND HOWARD DURUSSEL D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213EP1101XPrimary Podiatric Medicine Podiatrist5901001395MI
2213ES0103XFoot & Ankle Surgery Podiatrist0333NH
3213ES0103XFoot & Ankle Surgery Podiatrist0328NM

General Provider Information

NPI Number : 1417946591
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAYMOND HOWARD DURUSSEL D.P.M.
Provider Business Mailing Address
First Line : PO BOX 160
Second Line : US HWY 491 NORTH
City : SHIPROCK
State : NM
Zip : 87420-0160
Country : US
Telephone Number : 505-368-6651
Fax Number : 505-368-6651
Provider Business Practice Location Address
First Line : US HWY. 491 NORTH
Second Line :
City : SHIPROCK
State : NM
Zip : 87420-0160
Country : US
Telephone Number : 505-368-6651
Fax Number : 505-368-7078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 05/02/2014

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