Individual
GERALD B BROUSSARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
R2826
KY
2085R0202X
Diagnostic Radiology Physician
Primary
24982
MS
2085R0202X
Diagnostic Radiology Physician
R2826
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07124262
—
MS
Enumeration date
05/02/2011
Last updated
05/06/2026
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