Individual
DUSTIN COLE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
312 GRAMMONT ST STE 100, MONROE, LA 71201-7457
(318) 998-6129
Mailing address
PO BOX 3185, MONROE, LA 71210-3185
(318) 998-6129
(318) 812-1755
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP06688
LA
367500000X
Certified Registered Nurse Anesthetist
RN9306451
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003203300
—
FL
05
—
125633
—
AL
01
—
592-13560
BLUE CROSS BLUE SHIELD
AL
01
—
P00924079
RAILROAD MEDICARE
—
01
—
Y06R8
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/13/2011
Last updated
10/25/2017
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