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NPI Code Detail

MEDICARE: DR. JEFFERY BERNARD BREAUX M.D.

MEDICARE: DR. JEFFERY BERNARD BREAUX M.D.
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
1207R00000XInternal Medicine Physician31036KY

General Provider Information

NPI Number : 1851355671
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFERY BERNARD BREAUX M.D.
Provider Business Mailing Address
First Line : 109 BUENA VISTA DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-2125
Country : US
Telephone Number : 606-325-8724
Fax Number :
Provider Business Practice Location Address
First Line : 1540 SPRING VALLEY DR
Second Line :
City : HUNTINGTON
State : WV
Zip : 25704-9300
Country : US
Telephone Number : 304-429-6741
Fax Number : 304-429-6741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 12/02/2013

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