Broussard, Heath

Broussard, Heath is an individual health care provider with primary practice located at 700 W Forest Ave Ste 300, Jackson TN 38301-3937. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Broussard, Heath can be contacted via phone (731) 422-0310.

Contact Information

Primary practice address
700 W Forest Ave Ste 300 Jackson TN 38301-3937
Phone: (731) 422-0310
Fax: (731) 422-0440
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 31232 Tennessee

Profile Details

NPI number 1801881958
LBN Legal business name Broussard, Heath
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2005
Last updated Nov 29th, 2012 - about 12 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 1801881958 NPPES
Tennessee MEDICAID 3832620

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