Healthcare Provider Details

I. General information

NPI: 1235115486
Provider Name (Legal Business Name): JOSEPH N BROYLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST SUITE 100
BATON ROUGE LA
70817-5126
US

IV. Provider business mailing address

500 RUE DE LA VIE ST SUITE 100
BATON ROUGE LA
70817-5126
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-2000
  • Fax: 225-201-2110
Mailing address:
  • Phone: 225-201-2000
  • Fax: 225-201-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number011471
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: