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Gerald B Broussard JR., MD
Diagnostic Radiology Physician in Hattiesburg, Mississippi
NPI 1104117688

Gerald B Broussard JR. is a Diagnostic Radiology Physician based in Hattiesburg, MS and is specialized in Diagnostic Radiology. Gerald B Broussard JR. practices in Hattiesburg, MS and has the professional credentials of MD. The NPI Number for Gerald B Broussard JR. is 1104117688 and holds a License No. R2826 (Mississippi).

The current practice location address for Gerald B Broussard JR. is 6051 U S Highway 49, Hattiesburg, MS and can be reached out via phone at 800-494-8260 and via fax at 859-368-0437. You can also correspond with Gerald B Broussard JR. through the mailing address at 5000 W 4TH ST, HATTIESBURG, MS - 39402-1000 (mailing address contact number: 800-494-8260).

Location: 6051 U S Highway 49, Hattiesburg, MS, 39402-1000
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104117688
Provider Name
Gerald B Broussard JR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
6051 U S Highway 49, Hattiesburg, MS, 39402-1000
Phone Number
800-494-8260
Fax Number
859-368-0437
Provider Enumeration Date
05/02/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
07124262 05 MS
institution
Provider Business Practice Location Address Details
Address
6051 U S Highway 49
City
Hattiesburg
State
Mississippi
Zip
39401-7200
Phone Number
800-494-8260
Fax Number
859-368-0437
person
Provider Business Mailing Address Details
Address
5000 W 4Th St
City
Hattiesburg
State
Mississippi
Zip
39402-1000
Phone Number
800-494-8260
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Addiction Medicine
Taxonomy
207RA0401X
License No.
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Definition
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
2085R0202X
License No.
R2826 (Kentucky)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
person
Provider's Taxonomy Details 3
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
R2826 (Kentucky)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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