Healthcare Provider Details

I. General information

NPI: 1437788395
Provider Name (Legal Business Name): ANDREW BROUSSARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY # CA-2
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

122 HAWTHORNE RD
LAFAYETTE LA
70508-5600
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-6829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number336444
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: