Provider Demographics
NPI:1487975447
Name:BROUSSARD, JOHNECA ROCHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:JOHNECA
Middle Name:ROCHELLE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:108 S WILLIAM BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327
Mailing Address - Country:US
Mailing Address - Phone:281-659-2355
Mailing Address - Fax:281-592-1570
Practice Address - Street 1:309 HIGHWAY 59 SOUTH LOOP
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-1055
Practice Address - Fax:936-329-8800
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10036752207Q00000X
TXP6146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine