Provider Demographics
NPI:1417946591
Name:DURUSSEL, RAYMOND HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HOWARD
Last Name:DURUSSEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:US HWY 491 NORTH
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6651
Mailing Address - Fax:505-368-6651
Practice Address - Street 1:US HWY. 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-0160
Practice Address - Country:US
Practice Address - Phone:505-368-6651
Practice Address - Fax:505-368-7078
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001395213EP1101X
NH0333213ES0103X
NM0328213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine