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General NPI Number Information
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NPI Number | 1669606422
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Entity Type | Individual
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Provider Name | BRETT LOUIS BROUSSARD MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | BANNER BOSWELL SURGICAL ONCOLOGY 13188 N. 103RD DRIVE, SUITE 200
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-832-3444
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Fax | 623-832-3470
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Provider Business Mailing Address
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Address Line | BANNER BOSWELL SURGICAL ONCOLOGY 13188 N. 103RD DRIVE, SUITE 200
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-832-3444
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Fax | 623-832-3470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 56911
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License Number State | AZ
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