Healthcare Provider Details

I. General information

NPI: 1841354628
Provider Name (Legal Business Name): RAYMOND P MUSSETT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E BRAVO BLVD
ROMA TX
78584-5720
US

IV. Provider business mailing address

PO BOX 1120
ROMA TX
78584-1120
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE8752
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM1437
License Number StateTX

VIII. Authorized Official

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