Individual
BRAD BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 HOSPITAL DR. STE 206, LAFAYETTE, LA 70503
(337) 234-3204
(337) 234-3599
Mailing address
155 HOSPITAL DR. STE 206, LAFAYETTE, LA 70503
(337) 234-3204
(337) 234-3599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3171
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
M3171
TX
207RP1001X
Pulmonary Disease Physician
M3171
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181131701
—
TX
01
—
8DCN 1365642 TICKET
BCBS
TX
01
—
8M1458
BCBS TX PROVIDER NO.
TX
01
—
P00473770
RR MCR
—
Enumeration date
07/17/2006
Last updated
09/04/2014
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