Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JOHN BROUSSARD, DO
Active Sole ProprietorDR. JOHN BROUSSARD, DO is a Sports Medicine healthcare provider located in ST PETERSBURG, Florida. NPI 1174839161 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine · ST PETERSBURG, FL
Registration Details
- NPI Number
- 1174839161
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 27, 2010 (15.92013818011 yrs)
- Last Updated
- Aug 27, 2020
- Licenses
-
OS12241 (FL)0102204383 (VA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
111 2ND AVE NE STE 1401ST PETERSBURG, FL, 337013480Browse FL providers · Browse ZIP 33701
- Phone
- 7272587224
- Primary Specialty
-
Sports Medicine
207QS0010X
- Additional Specialty
- Sports Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.