Individual
MR. PAUL W BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 N LEWIS ST, NEW IBERIA, LA 70560
(337) 365-3168
(337) 369-3536
Mailing address
2669 SCENIC DR, ALAMOGORDO, NM 88310-8700
(337) 365-3168
(337) 369-3536
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
037524
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA-01145
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1696609
—
LA
Enumeration date
10/05/2006
Last updated
10/24/2017
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