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Contact Information

JOHN BROUSSARD, DO
111 2ND AVE NE STE 1401
SAINT PETERSBURG, FL33701-3480
 Phone: 727-258-7224
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JOHN BROUSSARD · (Male)

NPI Number 1174839161
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 08/27/2010
Last updated 08/27/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # OS12241
  • VA License # 0102204383
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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