19D0931851 CLIA NUMBER - BRUCE BROUILLETTE, MD

Laboratory Demographics

  • CLIA Code: 19D0931851
  • Facility Name: BRUCE BROUILLETTE, MD
  • Facility Address: 5621 NORTH MARKET, SUITE 120
    SHREVEPORT, LA
    ZIP 71107
  • Facility Phone: 318 935-1724
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: BRUCE BROUILLETTE
  • NPI Number: 1194753913
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D0931851
LAB Type Physician Office
Facility Name BRUCE BROUILLETTE, MD
Street 5621 NORTH MARKET, SUITE 120
City SHREVEPORT
State LA
ZIP 71107
Phone 318 935-1724
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director BRUCE BROUILLETTE

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This page was last updated on: 9/29/2025