Individual
MICHAEL A. BROUILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 857-1850
Mailing address
623 WILLIAM DR, OVILLA, TX 75154-3611
(972) 515-3302
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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