Provider Demographics
NPI:1679747208
Name:DR. DAVID M. BROUSSARD, P.C.
Entity type:Organization
Organization Name:DR. DAVID M. BROUSSARD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-403-1359
Mailing Address - Street 1:5601 DEMOCRACY DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3687
Mailing Address - Country:US
Mailing Address - Phone:972-403-1359
Mailing Address - Fax:972-403-1378
Practice Address - Street 1:5601 DEMOCRACY DR
Practice Address - Street 2:SUITE 225
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3687
Practice Address - Country:US
Practice Address - Phone:972-403-1359
Practice Address - Fax:972-403-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health