Provider Demographics
NPI:1154326437
Name:BREAUX, STEVEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:BREAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7201
Mailing Address - Country:US
Mailing Address - Phone:563-242-3208
Mailing Address - Fax:563-242-4051
Practice Address - Street 1:242 N BLUFF BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7119
Practice Address - Country:US
Practice Address - Phone:563-243-0100
Practice Address - Fax:563-243-0550
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098987207V00000X
IA36950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154326437Medicaid
IL036098987Medicaid
IL036098987Medicaid
G84217Medicare UPIN