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General NPI Number Information
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NPI Number | 1437608007
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Entity Type | Individual
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Provider Name | CARRIE BOROUGHS BREAUX DVM DACVO
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Gender | Female
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 5019 N SAWYER AVE
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City | GARDEN CITY
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State | ID
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Zip | 83714
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Country | US
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Telephone | 208-375-1600
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Fax | 208-375-1606
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Provider Business Mailing Address
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Address Line | 5019 N SAWYER AVE
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City | GARDEN CITY
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State | ID
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Zip | 83714
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Country | US
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Telephone | 208-375-1600
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Fax | 208-375-1606
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | V3922
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License Number State | ID
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