Provider Demographics
NPI:1922099662
Name:BROUSSARD, YANG-TZE YOKO (MD)
Entity type:Individual
Prefix:MRS
First Name:YANG-TZE
Middle Name:YOKO
Last Name:BROUSSARD
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 1:501 DOCTOR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-433-8400
Mailing Address - Fax:337-439-4484
Practice Address - Street 1:1722 WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5743
Practice Address - Country:US
Practice Address - Phone:337-439-2200
Practice Address - Fax:337-439-4484
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022167207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483320Medicaid
LA1483320Medicaid
LAG67804Medicare UPIN
LAP01052180Medicare PIN
LA5A2887460Medicare PIN