MEDICARE: TIMOTHY GERALD BREAUX JR. CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN085125	LA
2	367500000X	Certified Registered Nurse Anesthetist	AP04031	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	:	1770537136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY GERALD BREAUX JR. CRNA

Provider Business Mailing Address
First Line	:	744 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1909
Country	:	US
Telephone Number	:	800-242-1131
Fax Number	:	517-787-4146

Provider Business Practice Location Address
First Line	:	2021 PERDIDO ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-1352
Country	:	US
Telephone Number	:	504-903-3370
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/13/2007

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