Individual provider Active NPI

Curtis A Broussard, MD

  • General Practice Physician
  • Gulfport, MS
National Provider Identifier
1447248661
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
09015 Issued in MS
Practice address
12330 Ashley Dr
Gulfport, MS 39503-2737
Phone
(228) 831-1572
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 09015 MS Primary

Addresses

Primary practice location

12330 Ashley Dr
Gulfport, MS 39503-2737

Mailing address

12330 Ashley Dr
Gulfport, MS 39503-2737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051130000840 MS Practitioner - Family Practice 4082634415 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
09015MSMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Gulfport CurrentSince Oct 1, 2020 Accepting new patients
Singing River Gulfport CurrentSince Oct 1, 2020 Accepting new patients

Locations

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

12121 Highway 49
Gulfport, MS 39503
Phone (228) 831-1572

12330 Ashley Dr
Gulfport, MS 39503
Phone (228) 255-8818

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1447248661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12330 ASHLEY DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12330 ASHLEY DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032737",
            "telephone_number": "228-831-1572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "CURTIS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MS",
            "license": "09015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.