Provider Demographics
NPI:1093822140
Name:RAYMOND P MUSSETT MD PLLC
Entity Type:Organization
Organization Name:RAYMOND P MUSSETT MD PLLC
Other - Org Name:ROMA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-849-2176
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584
Mailing Address - Country:US
Mailing Address - Phone:956-849-2176
Mailing Address - Fax:956-849-3439
Practice Address - Street 1:640 E BRAVO BLVD
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584
Practice Address - Country:US
Practice Address - Phone:956-849-2176
Practice Address - Fax:956-849-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX827083763OtherPALMETTO MEDICARE
TX135201506Medicaid
TX00734HFOtherBCBS
TX063426301Medicaid
TX00734HFOtherBCBS
TX135201506Medicaid