Healthcare Provider Details

I. General information

NPI: 1912773250
Provider Name (Legal Business Name): REBECCA JEWEL BROUSSARD AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MCFARLAND BLVD NE STE A
TUSCALOOSA AL
35406-2288
US

IV. Provider business mailing address

1224 MCFARLAND BLVD NE STE A
TUSCALOOSA AL
35406-2288
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-3330
  • Fax: 205-333-3331
Mailing address:
  • Phone: 205-333-3330
  • Fax: 205-333-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1335A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: