Active NPI
Harold Joseph Broussard, PA
- Medical Physician Assistant
- New Iberia, LA
National Provider Identifier
1144352287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA.A10075.RX
- Practice address
- 2309 E Main St
BLDG B
New Iberia, LA 70560-4046 - Phone
- (337) 560-0931
- Fax
- (337) 560-0934
- NPI assigned
- Mar 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA.A10075.RX | LA | Primary |
Addresses
Primary practice location
2309 E Main St
BLDG B
New Iberia, LA 70560-4046
Mailing address
2309 E Main St
BLDG B
New Iberia, LA 70560-4046
Phone (337) 560-0931
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA.A10075.RX | Other | LA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.A10075.RX | LA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teche Occupational Medicine Clinic | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Medicine Clinic/Center
- New Iberia, LA
- NPI 1932231065
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144352287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2309 E MAIN ST",
"address_2": "BLDG B",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705604046",
"telephone_number": "337-560-0931",
"fax_number": "337-560-0934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2309 E MAIN ST",
"address_2": "BLDG B",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705604046",
"telephone_number": "337-560-0931",
"fax_number": "337-560-0934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "HAROLD",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "LA",
"license": "PA.A10075.RX",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "PA.A10075.RX",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Iberia, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.