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Individual

JO DEE GOODEAUX BROUSSARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
108 RUE LOUIS XIV, LAFAYETTE, LA 70508-5739
(337) 235-8007
(855) 270-5479
Mailing address
108 RUE LOUIS XIV, LAFAYETTE, LA 70508-5739
(337) 235-8007
(855) 270-5479

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200320
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1808181
LA
Enumeration date
11/04/2009
Last updated
10/06/2017
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