Shane T Broussard (NPI# 1164468435, PAC ID# 9830109776) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1164468435 |
| PAC ID by PECOS | 9830109776 |
| Professional Enrollment ID | I20090612000434 |
| Full Name | Shane T Broussard |
| Organization Legal Name | SOUTHERN LOUISIANA REHAB LLC |
| Address |
600 N Lewis Ave New Iberia LA 70563-2043 |
| Phone Number | 3373744100 |
| Gender | M |
| Graduation Year | 1997 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 8820066228 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 600 N Lewis Ave, New Iberia, LA 70563-2043 | 3373744100 | SOUTHERN LOUISIANA REHAB LLC |
| 539 E Prudhomme St, Opelousas, LA 70570-6499 | 3379483011 | SOUTHERN LOUISIANA REHAB LLC |
| Organization Legal Name | SOUTHERN LOUISIANA REHAB LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joseph R Bozzelle | Physical Medicine and Rehabilitation | Southern Louisiana Rehab LLC | 600 N Lewis Ave, New Iberia, LA 70563-2043 |
| Street Address |
600 N LEWIS AVE |
| City | NEW IBERIA |
| State | LA |
| Zip | 70563-2043 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joseph R Bozzelle | Physical Medicine and Rehabilitation | Southern Louisiana Rehab LLC | 600 N Lewis Ave, New Iberia, LA 70563-2043 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bryan D Granger | Optometry | 1110 Angers St, New Iberia, LA 70563-2012 | |
| Vina S Baker | Internal Medicine | 602 N Lewis Ave, Suite 100, New Iberia, LA 70563-2014 | |
| Julian J Krawczyk | Radiation Oncology | Acadiana Radiation Therapy LLC | 525 N Lewis St, New Iberia, LA 70563-2015 |
| John F. Anderson | Radiation Oncology | Acadiana Radiation Therapy LLC | 525 N Lewis St, New Iberia, LA 70563-2015 |
| Stephen R Wilt | Radiation Oncology | Acadiana Radiation Therapy LLC | 525 N Lewis St, New Iberia, LA 70563-2015 |
| Jonathan W Thompson | Radiation Oncology | Acadiana Radiation Therapy LLC | 525 N Lewis St, New Iberia, LA 70563-2015 |
| Charles R Reinninger | Radiation Oncology | Acadiana Radiation Therapy LLC | 525 N Lewis St, New Iberia, LA 70563-2015 |
| Daniel M Bitner | Anesthesiology | Youngs Professional Services LLC | 600 N Lewis St, Anesthesia Dept, New Iberia, LA 70563-2043 |
| Hai H. Tran | Anesthesiology | Youngs Professional Services LLC | 600 N Lewis St, Anesthesia Dept, New Iberia, LA 70563-2043 |
| Salvatore Buttaci-guarino | Interventional Cardiology | Cardiovascular Institute of The South, Apmc | 500 N Lewis St, 100 Cardiovascular Inst of South New Ib, New Iberia, LA 70563-2046 |
| Find all physicians in zip 70563 | |||
| City | NEW IBERIA |
| Zip Code | 70563 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | NEW IBERIA + PHYSICIAN ASSISTANT |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.