Provider Demographics
NPI:1538909189
Name:BROUSSARD PRIMARY CARE, LLC
Entity type:Organization
Organization Name:BROUSSARD PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-263-4104
Mailing Address - Street 1:3301 S ALAMEDA ST STE 212
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1892
Mailing Address - Country:US
Mailing Address - Phone:361-452-2480
Mailing Address - Fax:361-452-2484
Practice Address - Street 1:3301 S ALAMEDA ST STE 212
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1892
Practice Address - Country:US
Practice Address - Phone:361-452-2480
Practice Address - Fax:361-452-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty