Broussard, Blaine Mark

Broussard, Blaine Mark is an individual health care provider with primary practice located at 176 Versailles Blvd , Alexandria LA 71303-2493. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Broussard, Blaine Mark can be contacted via phone (318) 445-9331.

Contact Information

Primary practice address
176 Versailles Blvd Alexandria LA 71303-2493
Phone: (318) 445-9331
Fax: (318) 619-6899
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 206014 Louisiana
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 206014 Louisiana

Profile Details

NPI number 1023251659
LBN Legal business name Broussard, Blaine Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2009
Last updated May 24th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023251659 NPPES
Louisiana MEDICAID 2339605

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