Provider Demographics
NPI:1316991722
Name:E. PAUL BREAUX III MD PMC
Entity type:Organization
Organization Name:E. PAUL BREAUX III MD PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-237-5774
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADE1593OtherGROUP RAILROAD MEDICARE #
LA1799467Medicaid
LA1799467Medicaid