Jody Mack Broussard
Jody Mack Broussard is a Driver in Deridder, Louisiana. Practices as a sole proprietor. Licensed in Louisiana.
- Licensed in
- LA
- In the registry since
- 2018
Practice location Address checks out
494 Otto Franklin RdDeridder, LA 70634-6404
Phone: (337) 396-1312
Fax: (337) 462-0283
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Driver (primary) | Taxonomy 172A00000X · Licence 005855942 (LA) |
|---|
Record details
| NPI number | 1659871796 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | February 15, 2018 |
| Last updated in NPPES | February 15, 2018 |