Provider Demographics
NPI:1942296751
Name:BREAUX, LORI ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANTOINETTE
Last Name:BREAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 MARYLAND WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7513
Mailing Address - Country:US
Mailing Address - Phone:615-661-4256
Mailing Address - Fax:615-661-4253
Practice Address - Street 1:5111 MARYLAND WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7513
Practice Address - Country:US
Practice Address - Phone:615-661-4256
Practice Address - Fax:615-661-4253
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD31851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3898198Medicaid
TN1502886Medicaid
TN1502886Medicaid