Provider Demographics
NPI:1467574616
Name:BREEN, JOSEPH T (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:BREEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 JANES RD
Mailing Address - Street 2:STE 9
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4745
Mailing Address - Country:US
Mailing Address - Phone:707-599-8677
Mailing Address - Fax:707-559-8176
Practice Address - Street 1:3798 JANES RD STE 9
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4745
Practice Address - Country:US
Practice Address - Phone:707-599-8677
Practice Address - Fax:707-559-8176
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO621213E00000X
CAE4481213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831918Medicaid
CA1639465206Medicaid
AZ8HBW59Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
AZ8HBW58Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZH53073Medicare UPIN
CA1639465206Medicaid
AZ831918Medicaid