Provider Demographics
NPI:1437608007
Name:BREAUX, CARRIE BOROUGHS (DVM DACVO)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:BOROUGHS
Last Name:BREAUX
Suffix:
Gender:F
Credentials:DVM DACVO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 N SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714
Mailing Address - Country:US
Mailing Address - Phone:208-375-1600
Mailing Address - Fax:208-375-1606
Practice Address - Street 1:5019 N SAWYER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:208-375-1600
Practice Address - Fax:208-375-1606
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDV3922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology