Dr. John Broussard
Family Doctor - Sports Medicine
111 2nd Ave Ne Ste 1401
St Petersburg
, Florida 33701-3480
Dr. John Broussard
Family Doctor - Sports Medicine
111 2nd Ave Ne Ste 1401
St Petersburg
, Florida 33701-3480
(727) 258-7224
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About
Features
Specialties
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Dr. John Broussard
- 111 2nd Ave Ne Ste 1401
- St Petersburg, FL
- Zip : 33701-3480
- Phone : (727) 258-7224
Second Address
- Dr. John Broussard
- 111 2nd Ave Ne Ste 1401
- St Petersburg, FL
- Zip : 33701-3480
- Phone : (727) 258-7224
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207QS0010X | Family Doctor - Sports Medicine | 0102204383 | VA |
| Y | 207QS0010X | Family Doctor - Sports Medicine | OS12241 | FL |
National Provider Identifier
| NPI | 1174839161 |
|---|---|
| Provider Name | Dr. John Broussard |
| First Address | St Petersburg, FL 33701-3480 |
| Second Address | St Petersburg, FL 33701-3480 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/08/2010 |
| Last Update Date | 27/08/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.