Ronnie Broussard
Individual provider Active NPI Dentist · Rosharon, TX
NPI 1982013603 · NPPES record last updated Aug 6, 2014
Key facts
- NPI
- 1982013603
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 15697 (TX)
- Practice address
- 59 Darrington Rd
Rosharon, TX 77583-5057 - Phone
- (281) 595-3465
- NPI assigned
- Aug 6, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15697 | TX | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 15697 | TX | Yes |
Addresses
Primary practice location
59 Darrington Rd
Rosharon, TX 77583-5057
Mailing address
59 Darrington Rd
Rosharon, TX 77583-5057
Other providers in Rosharon, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.