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Individual
DR. JOHN BROUSSARD
Active
Individual
DR. JOHN BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
0102204383
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OS12241
FL
Other
Enumeration date
08/27/2010
Last updated
08/27/2020
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