Broussard, Ian Matthew

Broussard, Ian Matthew is an sole proprietor health care provider with primary practice located at 809 82Nd Pkwy Grand Strand Medical Center Gme Office, Myrtle Beach SC 29572-4607. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Broussard, Ian Matthew can be contacted via phone (843) 692-1752.

Contact Information

Primary practice address
809 82Nd Pkwy Grand Strand Medical Center Gme Office Myrtle Beach SC 29572-4607
Phone: (843) 692-1752
Fax: (843) 692-1904
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X South Carolina
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X LL41064 South Carolina

Profile Details

NPI number 1871024968
LBN Legal business name Broussard, Ian Matthew
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 21st, 2017
Last updated Jun 12th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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