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1114037314
BRIAN J BROUSSARD
LAFAYETTE, LA
NPI
1114037314
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: LA 04020)
Enumeration Date
2006-08-30
Last Update Date
2011-08-17
Business Address
-- BRIAN J BROUSSARD CRNA
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE, LA 70508-6917
Phone number: 337-470-2966
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Mailing Address
-- BRIAN J BROUSSARD CRNA
PO BOX 53864
LAFAYETTE, LA 70505-3864
Phone number: 337-289-2966
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