Individual
DR. TOBY D BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 RENAISSANCE BLVD, 2ND FLOOR, EDMOND, OK 73013-3023
(405) 359-2473
Mailing address
1800 RENAISSANCE BLVD, EDMOND, OK 73013-3023
(405) 359-2473
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
20450
LA
208600000X
Surgery Physician
Primary
24881
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1989592
—
LA
Enumeration date
06/09/2005
Last updated
06/07/2011
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