Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum

Gerald B Broussard Jr., MD

Diagnostic Radiology Physician in Hattiesburg, MS · enumerated 2011.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1104117688

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Registry record

Entity type Individual (Type 1)

Name Gerald B Broussard Jr.

Credential MD

Sex Male

Practice address 6051 U S Highway 49, Hattiesburg, MS, 39401

Phone (800) 494-8260

Fax (859) 368-0437

Enumeration date May 2, 2011

Last updated in NPPES May 6, 2026

Taxonomy & licenses

2085R0202X Diagnostic Radiology Physician Allopathic & Osteopathic Physicians · License R2826 (KY) Secondary

390200000X Student in an Organized Health Care Education/Training Program Student, Health Care Secondary

207RA0401X Addiction Medicine (Internal Medicine) Physician Allopathic & Osteopathic Physicians · License R2826 (KY) Secondary

2085R0202X Diagnostic Radiology Physician Allopathic & Osteopathic Physicians · License 24982 (MS) Primary

MD · Doctor of Medicine: A physician who completed medical school (allopathic medicine), residency training, and state licensure. About the MD credential

Other identifiers

Identifier	Type	State	Issuer
07124262	Medicaid	MS	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

How do I verify Gerald Broussard's NPI record?

Cross-check NPI 1104117688 against the official CMS registry at npiregistry.cms.hhs.gov. This page mirrors the same public NPPES data with a monthly snapshot.

Is NPI 1104117688 active?

Yes, as of the latest NPPES snapshot, NPI 1104117688 is active (record last updated 2026-05-06).

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2026-05-06.