Individual
GREG A BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4801 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6917
(337) 470-2966
(337) 470-2776
Mailing address
PO BOX 53864, LAFAYETTE, LA 70505-3864
(337) 470-2966
(337) 470-2776
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN112825AP06765
LA
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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