Individual
MARLENE MARIE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF PEDIATRICS, SHREVEPORT, LA 71103-4228
(318) 675-8600
(318) 675-8638
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-7636
(318) 675-8638
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
024730
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1577995
—
LA
Enumeration date
07/20/2006
Last updated
07/09/2012
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