Individual
DR. ISSAC DUANE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 RAWLS DR, MCCOMB, MS 39648-2833
(601) 684-0465
(601) 684-3031
Mailing address
PO BOX 30309, CHARLESTON, SC 29417-0309
(843) 284-3400
(843) 284-3401
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
12940
MS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
12940
MS
Other
Enumeration date
02/07/2006
Last updated
01/22/2008
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