Organization
AMBULATORY SURGERY CENTER SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J BROUSSARD MD (PRESIDENT)
(321) 727-2020
Entity
Organization
Contact information
Practice address
719 E NEW HAVEN AVE, MELBOURNE, FL 32901-5459
(321) 984-4405
(321) 984-9547
Mailing address
502 E NEW HAVEN AVE, MELBOURNE, FL 32901-5427
(321) 727-2020
(321) 984-9547
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
19959
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259253300
—
FL
Enumeration date
05/15/2006
Last updated
05/22/2008
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