Provider Demographics
NPI:1235115486
Name:BROYLES, JOSEPH N (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:N
Last Name:BROYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011471207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135216Medicaid
LA1135216Medicaid