Provider Demographics
NPI:1457531881
Name:BREAUX INTERNAL MEDICINE AND PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:BREAUX INTERNAL MEDICINE AND PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-491-7072
Mailing Address - Street 1:711 S RYAN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5785
Mailing Address - Country:US
Mailing Address - Phone:337-491-7072
Mailing Address - Fax:337-491-7076
Practice Address - Street 1:711 S RYAN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5785
Practice Address - Country:US
Practice Address - Phone:337-491-7072
Practice Address - Fax:337-491-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0700011300261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center