Provider Demographics
NPI:1417941907
Name:BREEDLOVE, JAMES W (D P M)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARINA ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2244
Mailing Address - Country:US
Mailing Address - Phone:805-543-3025
Mailing Address - Fax:805-543-2740
Practice Address - Street 1:275 MARINA ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2244
Practice Address - Country:US
Practice Address - Phone:805-543-3025
Practice Address - Fax:805-543-2740
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2024-04-10
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CAE3976213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480021688OtherRAILROAD MEDICARE
CA000E39760Medicaid
CA000E39760Medicaid
CA480021688OtherRAILROAD MEDICARE