Provider Demographics
NPI:1306870530
Name:BROUSSARD PERRY, DANA L (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:BROUSSARD PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-876-1009
Mailing Address - Fax:407-876-6742
Practice Address - Street 1:8946 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3128
Practice Address - Country:US
Practice Address - Phone:407-876-1009
Practice Address - Fax:407-876-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68693207K00000X, 2080P0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5184005OtherAETNA
FL6608772006OtherCIGNA
FL27553OtherBLUE CROSS BLUE SHIELD
FL5184005OtherAETNA