Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 5901001395 | MI |
N | 213ES0103X | Foot & Ankle Surgery | 0328 | NM |
Y | 213ES0103X | Foot & Ankle Surgery | 0333 | NH |
NPI | 1417946591 |
---|---|
Provider Name | Dr. Raymond Howard Durussel |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420-0160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 02/05/2014 |