Healthcare Provider Details

I. General information

NPI: 1093822140
Provider Name (Legal Business Name): RAYMOND P MUSSETT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E BRAVO BLVD
ROMA TX
78584
US

IV. Provider business mailing address

PO BOX 1120
ROMA TX
78584
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-2176
  • Fax: 956-849-3439
Mailing address:
  • Phone: 956-849-2176
  • Fax: 956-849-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: RAYMOND P MUSSETT
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 956-849-2176