Provider Demographics
NPI:1003810979
Name:TOBY D. BROUSSARD, M.D., APMC
Entity Type:Organization
Organization Name:TOBY D. BROUSSARD, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROUSSARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-407-0893
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-1206
Mailing Address - Country:US
Mailing Address - Phone:337-407-0893
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:STE 101
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-407-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1989592Medicaid
LAE46995Medicare UPIN
LA4A407Medicare ID - Type Unspecified