Provider Demographics
NPI:1841354628
Name:RAYMOND P MUSSETT MD PLLC
Entity type:Organization
Organization Name:RAYMOND P MUSSETT MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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:78584-1120
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:78584-5720
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:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8752207Q00000X
TXM1437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25048Medicare UPIN
TXI45325Medicare UPIN
TX00794ZMedicare ID - Type Unspecified