Individual
DR. THAD STEPHENS BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8037 PICARDY AVE, BATON ROUGE, LA 70809-3538
(225) 767-3680
(225) 767-5578
Mailing address
8037 PICARDY AVE, BATON ROUGE, LA 70809-3538
(225) 767-3680
(225) 767-5578
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
014869
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1340901
—
LA
01
—
2695399
CIGNA
LA
01
—
690092
AETNA
LA
Enumeration date
07/12/2005
Last updated
03/14/2008
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