MEDICARE: DR. JOHN RICHARD 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	018176	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	721349588	OTHER	LA	TAX ID

General Provider Information

NPI Number	:	1760487680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD BREAUX MD

Provider Business Mailing Address
First Line	:	64040 HIGHWAY 434
Second Line	:	SUITE 200
City	:	LACOMBE
State	:	LA
Zip	:	70445-3499
Country	:	US
Telephone Number	:	985-882-6221
Fax Number	:	985-882-7935

Provider Business Practice Location Address
First Line	:	64040 HIGHWAY 434
Second Line	:	SUITE 200
City	:	LACOMBE
State	:	LA
Zip	:	70445-3499
Country	:	US
Telephone Number	:	985-882-6221
Fax Number	:	985-882-7935

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/26/2022

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Directions to “ DR. JOHN RICHARD BREAUX MD” Practice Location

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