Broussard, Raymond Eddie
Broussard, Raymond Eddie is an individual health care provider with primary practice located at 1724 Grande Blvd , Rio Rancho NM 87124. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Broussard, Raymond Eddie can be contacted via phone (505) 896-0245.Contact Information
Primary practice address
1724 Grande Blvd
Rio Rancho NM 87124
Phone: (505) 896-0245
Fax: (505) 892-7579
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DD1745 | New Mexico |
Profile Details
| NPI number | 1558478560 |
|---|---|
| LBN Legal business name | Broussard, Raymond Eddie |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558478560 | NPPES |
| New Mexico | MEDICAID | 83918 |
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