Individual
MR. JEREMY WILLIAM BROUILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
ACADEMY FOOT & ANKLE SPECIALISTS, 1940 E. STATE HWY 114, SUITE 150, SOUTHLAKE, TX 76092-6526
(817) 424-3668
(817) 442-8637
Mailing address
1940 E. STATE HWY 114, SUITE 150, SOUTHLAKE, TX 76092-6526
(817) 424-3668
(817) 442-8637
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
692085
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
0103301199
VA
213ES0103X
Foot & Ankle Surgery Podiatrist
10448
WV
Other
Enumeration date
07/07/2014
Last updated
03/06/2025
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