Healthcare Provider Details

I. General information

NPI: 1790734788
Provider Name (Legal Business Name): RAYMOND NMN BROUGHTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13833 TAPIA AVE
BAYOU LA BATRE AL
36509-2515
US

IV. Provider business mailing address

PO BOX 769
BAYOU LA BATRE AL
36509-0769
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-8320
  • Fax: 251-824-3444
Mailing address:
  • Phone: 251-824-2174
  • Fax: 251-824-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12358
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.12358
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: