Provider Demographics
NPI:1588658751
Name:MUSSETT, RAYMOND P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:P
Last Name:MUSSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-0717
Mailing Address - Country:US
Mailing Address - Phone:956-534-7755
Mailing Address - Fax:956-849-4155
Practice Address - Street 1:PO BOX 717
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-0717
Practice Address - Country:US
Practice Address - Phone:956-847-8237
Practice Address - Fax:956-849-4155
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135201501Medicaid
TX135201506Medicaid
TX063426301Medicaid
TX1588658751Medicaid
TX0073HFOtherBCBS
TX063426301Medicaid
TX063426301Medicaid