JODY MACK BROUSSARD
NPI 1659871796
Driver in Deridder, LA
Active since February 15, 2018
About Jody Mack Broussard NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JODY MACK BROUSSARD (NPI 1659871796) is an individual driver provider in Deridder, Louisiana, licensed in Louisiana (005855942) and active in the NPI registry since February 2018.
NPPES Registry Identity
NPI1659871796
Entity TypeIndividualMale
Primary Taxonomy172A00000X
Provider Legal NameJODY MACK BROUSSARD
Location Address494 OTTO FRANKLIN RDDeridder, LA 70634-6404
Mailing Address494 Otto Franklin RdDeridder, LA 70634-6404 · (337) 396-1312 · Fax (337) 462-0283
Phone(337) 396-1312
Fax(337) 462-0283
Sole ProprietorYes
Enumeration DateFebruary 15, 2018
✔ NPI 1659871796 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyDriverOther Service Providers
Taxonomy Code172A00000X
License✔ Licensed in LA · 005855942
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
494 OTTO FRANKLIN RD, Deridder, LA 70634
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1659871796, enumerated as an "individual" on February 15, 2018.
The provider is located at 494 OTTO FRANKLIN RD DERIDDER, LA 70634 and the phone number is (337) 396-1312.
Driver with taxonomy code 172A00000X.
