Broussard, Gerald B

Broussard, Gerald B is an individual health care provider with primary practice located at 6051 U S Highway 49 , Hattiesburg MS 39401-7200. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Broussard, Gerald B can be contacted via phone (800) 494-8260.

Contact Information

Primary practice address
6051 U S Highway 49 Hattiesburg MS 39401-7200
Phone: (800) 494-8260
Fax: (859) 368-0437
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X R2826 Kentucky
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X R2826 Kentucky
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 24982 Mississippi

Profile Details

NPI number 1104117688
LBN Legal business name Broussard, Gerald B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2011
Last updated Jul 21st, 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 1104117688 NPPES
Mississippi MEDICAID 07124262

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