Healthcare Provider Details

I. General information

NPI: 1316991722
Provider Name (Legal Business Name): E. PAUL BREAUX III MD PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 COOLIDGE BLVD
LAFAYETTE LA
70503-2433
US

IV. Provider business mailing address

917 COOLIDGE BLVD
LAFAYETTE LA
70503-2433
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-5774
  • Fax: 337-237-4939
Mailing address:
  • Phone: 337-237-5774
  • Fax: 337-237-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGAR PAUL BREAUX III
Title or Position: OWNER/MANAGING MEMBER
Credential: M.D.
Phone: 337-237-5774