Provider Demographics
NPI:1982659165
Name:BREAUX, EDGAR PAUL III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:PAUL
Last Name:BREAUX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:PAUL
Other - Last Name:BREAUX
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:917 COOLIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2433
Mailing Address - Country:US
Mailing Address - Phone:337-237-5774
Mailing Address - Fax:337-237-4939
Practice Address - Street 1:917 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2433
Practice Address - Country:US
Practice Address - Phone:337-237-5774
Practice Address - Fax:337-237-4939
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309516Medicaid
LA1309516Medicaid
LA50632Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #