Individual
SHANE T BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1103 KALISTE SALOOM ROAD, SUITE 102, LAFAYETTE, LA 70508-2920
(337) 234-5234
(337) 235-2121
Mailing address
1103 KALISTE SALOOM ROAD, SUITE 102, LAFAYETTE, LA 70508-2920
(337) 234-5234
(337) 235-2121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10272
LA
Other
Enumeration date
06/22/2006
Last updated
02/03/2009
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