Healthcare Provider Details

I. General information

NPI: 1588658751
Provider Name (Legal Business Name): RAYMOND P MUSSETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 717
ROMA TX
78584-0717
US

IV. Provider business mailing address

PO BOX 717
ROMA TX
78584-0717
US

V. Phone/Fax

Practice location:
  • Phone: 956-847-8237
  • Fax: 956-849-4155
Mailing address:
  • Phone: 956-534-7755
  • Fax: 956-849-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE8752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: