MEDICARE: BRITTANI MCCLAIN BREAUX MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD208228	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093134256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANI MCCLAIN BREAUX MD

Provider Business Mailing Address
First Line	:	500 RUE DE LA VIE ST STE 515
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5129
Country	:	US
Telephone Number	:	225-924-8947
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RUE DE LA VIE ST STE 513
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5129
Country	:	US
Telephone Number	:	225-924-8947
Fax Number	:	225-924-8948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	09/21/2020

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