Individual
MARQUE D BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5400 GIBSON BLVD SE, ALBUQUERQUE, NM 87108-4729
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 676065, DALLAS, TX 75267-6065
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2005-0484
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A023
TRICARE
NM
01
—
P00302812
RAILROAD MEDICARE
NM
Enumeration date
06/05/2006
Last updated
07/08/2007
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