Individual
CRAIG V BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4345 NELSON RD STE 201, LAKE CHARLES, LA 70605-4183
(337) 494-6800
(337) 494-6811
Mailing address
PO BOX 122205, DEPT 2205, DALLAS, TX 75312-2205
(337) 494-2772
(337) 494-2928
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12750R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1540935
—
LA
01
—
MD.12750R
STATE MEDICAL LICENSE
LA
Enumeration date
04/04/2006
Last updated
04/27/2022
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