Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JODY MACK BROUSSARD
Active Sole ProprietorJODY MACK BROUSSARD is a Driver healthcare provider located in DERIDDER, Louisiana. NPI 1659871796 is currently active in the NPPES registry. Verify at CMS.
Driver · DERIDDER, LA
Registration Details
- NPI Number
- 1659871796
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 15, 2018 (8.4659589177742 yrs)
- Last Updated
- Feb 15, 2018
- License
-
005855942 (LA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
494 OTTO FRANKLIN RDDERIDDER, LA, 706346404Browse LA providers · Browse ZIP 70634
- Phone
- 3373961312
- Fax
- 3374620283
- Primary Specialty
-
Driver
172A00000X
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.