Provider Demographics
NPI:1508229618
Name:BROUSSE, BRANDON R (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:BROUSSE
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 1:131 CHEROKEE ROSE LN STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7244
Mailing Address - Country:US
Mailing Address - Phone:985-871-1721
Mailing Address - Fax:985-871-4049
Practice Address - Street 1:131 CHEROKEE ROSE LN STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7244
Practice Address - Country:US
Practice Address - Phone:985-871-1721
Practice Address - Fax:985-871-4049
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA330447207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program