Gerald B Broussard JR.
Internist - Addiction Medicine
6051 U S Highway 49
Hattiesburg
, Mississippi 39401-7200
Gerald B Broussard JR.
Internist - Addiction Medicine
6051 U S Highway 49
Hattiesburg
, Mississippi 39401-7200
(800) 494-8260
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About
Features
Specialties
- Internist - Addiction Medicine
Languages spoken
- English
Location
First Address
- Gerald B Broussard JR.
- 5000 W 4th St
- Hattiesburg, MS
- Zip : 39402-1000
- Phone : (800) 494-8260
Second Address
- Gerald B Broussard JR.
- 6051 U S Highway 49
- Hattiesburg, MS
- Zip : 39401-7200
- Fax : (859) 368-0437
- Phone : (800) 494-8260
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207RA0401X | Internist - Addiction Medicine | R2826 | KY |
National Provider Identifier
| NPI | 1104117688 |
|---|---|
| Provider Name | Gerald B Broussard JR. |
| First Address | Hattiesburg, MS 39402-1000 |
| Second Address | Hattiesburg, MS 39401-7200 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/05/2011 |
| Last Update Date | 28/07/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 07124262 | (05) | MS |
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.