Individual
HEATH BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W FOREST AVE, STE 300, JACKSON, TN 38301-3937
(731) 422-0310
(731) 422-0440
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
31232
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3832620
—
TN
Enumeration date
09/14/2005
Last updated
11/29/2012
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