MEDICARE: DANA L BROUSSARD PERRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	ME68693	FL
2	2080P0201X	Pediatric Allergy/Immunology Physician	ME68693	FL
3	207KA0200X	Allergy Physician	ME68693	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5184005	OTHER	FL	AETNA
2	6608772006	OTHER	FL	CIGNA
3	27553	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306870530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA L BROUSSARD PERRY MD

Provider Business Mailing Address
First Line	:	1507 S HIAWASSEE RD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5706
Country	:	US
Telephone Number	:	407-876-1009
Fax Number	:	407-876-6742

Provider Business Practice Location Address
First Line	:	8946 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-876-1009
Fax Number	:	407-876-6742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/24/2025

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Directions to “ DANA L BROUSSARD PERRY MD” Practice Location

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