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General NPI Number Information
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NPI Number | 1407844301
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Entity Type | Individual
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Provider Name | CHARLES W BREAUX JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1155 MILL ST
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-2125
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Fax | 775-982-2170
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Provider Business Mailing Address
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Address Line | PO BOX 507
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City | FRUITA
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State | CO
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Zip | 81521-0507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 11154
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35211
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 26701
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 11154
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 35211
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License Number State | CO
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Taxonomy #6
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 11154
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 35211
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License Number State | CO
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Taxonomy #8
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 26701
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License Number State | NV
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