GERALD B BROUSSARD JR. (NPI# 1104117688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104117688 |
| Entity Type | Individual |
| Full Name | GERALD B BROUSSARD JR. |
| Credential | MD |
| Practice Address |
6051 U S Highway 49 Hattiesburg MS 39401-7200 |
| Mailing Address |
5000 W 4th St Hattiesburg MS 39402-1000 |
| Practice Telephone | 8004948260 |
| Practice Fax Number | 8593680437 |
| Mailing Telephone | (800) 494-8260 |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2017-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
R2826 | KY | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
24982 | MS | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
R2826 | KY | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 07124262 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073511903 | Gerald Ball Broussard | Ophthalmology | 1250 Pecanland Rd, Suite E-1, Monroe, LA 71203-7011 | 2005-07-13 |
| 1437263712 | Gerald Broussard | Pharmacist | 805 Center St, New Iberia, LA 70560-5505 | 2006-08-17 |
| Street Address |
6051 U S HIGHWAY 49 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-7200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497730469 | James A York | Radiology | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2005-12-13 |
| 1952908105 | Steven Matthew Hudson | Pharmacist | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-10-01 |
| 1336767748 | Zackery Johnson | Nurse Practitioner | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-07-12 |
| 1629698741 | Cassandra Wood | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-18 |
| 1376162438 | Michael Andrew Mclarty | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-09 |
| 1942829171 | Kaleb King | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-04-08 |
| 1255950416 | Taylor Hairston | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-08 |
| 1285263103 | Courtney Lynn Cruthirds | Registered Nurse | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-04-02 |
| 1609409440 | Relias Emergency Medicine Specialists of Hattiesburg LLC | Emergency Medicine | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-02-20 |
| 1205487238 | Ashley Harper Miles | Nurse Practitioner | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2019-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497730469 | James A York | Radiology | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2005-12-13 |
| 1336140078 | Steven G Cunningham | Radiology | 5000 W 4th St, Hattiesburg, MS 39402-1000 | 2005-08-03 |
| 1003137084 | Jason P Eastlack | Radiology | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2010-06-14 |
| 1972784999 | William W. Boone | Radiology | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2007-11-19 |
| 1609939396 | Juan Velez, Jr | Radiology | 5000 W 4th St, Hattiesburg, MS 39402-1000 | 2006-12-18 |
| 1265502652 | Hattiesburg Clinic Pa | Radiology | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-11-09 |
| 1568556686 | Southern Medical Imaging | Radiology | 1 Lincoln Pkwy, Ste 300, Hattiesburg, MS 39402-3262 | 2006-10-03 |
| 1801826474 | Scott A Keeler | Radiology | 5000 W 4th St, Hattiesburg, MS 39402-1000 | 2006-07-03 |
| 1043249485 | Cleveland Alexander Hudson | Radiology | 5000 W 4th St, Hattiesburg, MS 39402-1000 | 2006-06-30 |
| 1760410245 | Kelly Seid | Radiology | 5000 W 4th St, Hattiesburg, MS 39402-1000 | 2006-06-30 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.