Shane T Broussard, P.A. Valid NPI

Individual provider · Physician Assistant · Lafayette, LA

NPI

1164468435

Type

Individual (Type 1)

Primary specialty

Physician Assistant

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363A00000X

License number

A10272 (LA)

Sex

Male

Sole proprietor

No

Enumerated

2006-06-22

Last updated

2009-02-03