Individual
JUDD TANNER BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1103 KALISTE SALOOM RD, SUITE 304, LAFAYETTE, LA 70508-5783
(337) 988-5646
(337) 988-4298
Mailing address
1103 KALISTE SALOOM RD, SUITE 304, LAFAYETTE, LA 70508-5783
(337) 988-5646
(337) 988-4298
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP04874
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581160
—
LA
Enumeration date
09/21/2006
Last updated
07/29/2010
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