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General NPI Number Information
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NPI Number | 1790734788
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Entity Type | Individual
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Provider Name | RAYMOND NMN BROUGHTON MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 13833 TAPIA AVE
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City | BAYOU LA BATRE
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State | AL
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Zip | 36509-2515
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Country | US
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Telephone | 251-824-8320
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Fax | 251-824-3444
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Provider Business Mailing Address
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Address Line | PO BOX 769
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City | BAYOU LA BATRE
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State | AL
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Zip | 36509-0769
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Country | US
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Telephone | 251-824-2174
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Fax | 251-824-2286
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12358
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD.12358
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License Number State | AL
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