Healthcare Provider Details

I. General information

NPI: 1720048226
Provider Name (Legal Business Name): GERARD J. BROUSSARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 HENNESSY BLVD STE 103
BATON ROUGE LA
70808-4794
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-4286
  • Fax: 225-765-5976
Mailing address:
  • Phone: 225-765-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.09989R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09989R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: