Provider Demographics
NPI:1699955021
Name:BREAULT, DANIEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:BREAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7680
Mailing Address - Fax:704-316-9368
Practice Address - Street 1:1202 MEDICAL CENTER DR
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-8824
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125049041207R00000X
NC2012-00830207RP1001X
FLME 100992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine