Individual
DR. STACY R BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
201 BJC SAINT PETERS DR STE 200, SAINT PETERS, MO 63376-3386
(636) 916-9615
Mailing address
PO BOX 959354, SAINT LOUIS, MO 63195-9354
(636) 916-9615
(636) 916-9850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2021045311
MO
207Q00000X
Family Medicine Physician
25MA06996700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3051404
—
NJ
Enumeration date
02/07/2007
Last updated
01/13/2026
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