Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. John Broussard, DO

Individual provider Sports Medicine (Family Medicine) Physician · NPI 1174839161

Dr. John Broussard, DO is a Sports Medicine (Family Medicine) Physician in St Petersburg, Florida. Practices as a sole proprietor. Licensed in Florida and Virginia.

Licensed in
FL, VA
In the registry since
2010
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

111 2nd Ave NE Ste 1401
St Petersburg, FL 33701-3480
Phone: (727) 258-7224
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X · Licence OS12241 (FL)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X · Licence 0102204383 (VA)

Record details

NPI number1174839161
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedAugust 27, 2010
Last updated in NPPESAugust 27, 2020
Certification dateAugust 27, 2020
Mailing address111 2nd Ave Ne Ste 1401, St Petersburg, FL 33701-3480

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