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Jody Mack Broussard
Driver in Deridder, Louisiana
NPI 1659871796

Jody Mack Broussard is a Driver based in Deridder, LA. Jody Mack Broussard practices in Deridder, LA. The NPI Number for Jody Mack Broussard is 1659871796 and holds a License No. 005855942 (Louisiana).

The current practice location address for Jody Mack Broussard is 494 Otto Franklin Rd, Deridder, LA and can be reached out via phone at 337-396-1312 and via fax at 337-462-0283.

Location: 494 Otto Franklin Rd, Deridder, LA, 70634-6404
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659871796
Provider Name
Jody Mack Broussard
Credential
Provider Entity Type
Individual
Gender
Male
Address
494 Otto Franklin Rd, Deridder, LA, 70634-6404
Phone Number
337-396-1312
Fax Number
337-462-0283
Provider Enumeration Date
02/15/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
494 Otto Franklin Rd
City
Deridder
State
Louisiana
Zip
70634-6404
Phone Number
337-396-1312
Fax Number
337-462-0283
person
Provider Business Mailing Address Details
Address
494 Otto Franklin Rd
City
Deridder
State
Louisiana
Zip
70634-6404
Phone Number
337-396-1312
Fax Number
337-462-0283
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
172A00000X
License No.
005855942 (Louisiana)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
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