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NPI Code Detail

MEDICARE: BRANDON R BROUSSE MD

MEDICARE: BRANDON R BROUSSE 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RG0100XGastroenterology Physician330447LA

General Provider Information

NPI Number : 1508229618
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON R BROUSSE MD
Provider Business Mailing Address
First Line : 131 CHEROKEE ROSE LN STE B
Second Line :
City : COVINGTON
State : LA
Zip : 70433-7244
Country : US
Telephone Number : 985-871-1721
Fax Number : 985-871-4049
Provider Business Practice Location Address
First Line : 131 CHEROKEE ROSE LN STE B
Second Line :
City : COVINGTON
State : LA
Zip : 70433-7244
Country : US
Telephone Number : 985-871-1721
Fax Number : 985-871-4049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2016
Last Update Date : 08/02/2022

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Directions to “ BRANDON R BROUSSE MD” Practice Location

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