MEDICARE: COLTON JOSEPH BROUSSARD

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1992633499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON JOSEPH BROUSSARD

Provider Business Mailing Address
First Line	:	1602 W PINHOOK RD STE 201
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-534-0770
Fax Number	:	337-534-4370

Provider Business Practice Location Address
First Line	:	1602 W PINHOOK RD STE 201
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-534-0770
Fax Number	:	337-534-4370

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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