Individual
JASON PAUL BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
424 W MCNEESE ST, LAKE CHARLES, LA 70605-5547
(337) 478-0511
(337) 478-5660
Mailing address
424 W MCNEESE ST, LAKE CHARLES, LA 70605-5547
(337) 478-0511
(337) 478-5660
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
128482
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP08637
LA
367500000X
Certified Registered Nurse Anesthetist
AP130328
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
529376ZMJF
MEDICARE PTAN
LA
Enumeration date
04/29/2016
Last updated
10/03/2016
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