Provider Demographics
NPI:1487752887
Name:BROUSSARD, RAYFUS JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYFUS
Middle Name:JOSEPH
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LONGFELLOW
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4845
Mailing Address - Country:US
Mailing Address - Phone:409-898-7847
Mailing Address - Fax:
Practice Address - Street 1:1120 LONGFELLOW
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4845
Practice Address - Country:US
Practice Address - Phone:409-898-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics