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Individual

DR. CHARLES W BREAUX JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1155 MILL ST, RENO, NV 89502-1576
(775) 982-2125
(775) 982-2170
Mailing address
PO BOX 507, FRUITA, CO 81521-0507

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
11154
AL
208600000X
Surgery Physician
26701
NV
208600000X
Surgery Physician
35211
CO
2086S0102X
Surgical Critical Care Physician
11154
AL
2086S0102X
Surgical Critical Care Physician
35211
CO
2086S0120X
Pediatric Surgery Physician
11154
AL
2086S0120X
Pediatric Surgery Physician
Primary
26701
NV
2086S0120X
Pediatric Surgery Physician
35211
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01352111
CO
05
10025031
NM
05
250035791
NV
01
BRB1426
BCBS PROVIDER NUMBER
CO
Enumeration date
10/13/2005
Last updated
01/16/2025
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