Healthcare Provider Details

I. General information

NPI: 1093134256
Provider Name (Legal Business Name): BRITTANI MCCLAIN BREAUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 513
BATON ROUGE LA
70817-5129
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 515
BATON ROUGE LA
70817-5129
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8947
  • Fax: 225-924-8948
Mailing address:
  • Phone: 225-924-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD208228
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: