Healthcare Provider Details

I. General information

NPI: 1356785356
Provider Name (Legal Business Name): BARRY ELLISON BREAUX JR. M.D., M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 SUTTER ST STE 5061104
SAN FRANCISCO CA
94108-4601
US

IV. Provider business mailing address

280 CALDECOTT LN UNIT 203
OAKLAND CA
94618-2416
US

V. Phone/Fax

Practice location:
  • Phone: 510-384-2846
  • Fax: 510-570-1989
Mailing address:
  • Phone: 510-384-2846
  • Fax: 510-570-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA145209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: