Individual
BLAKE LEONARD BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E CHEVES ST STE 260, FLORENCE, SC 29506-2652
(843) 665-7941
(843) 665-1257
Mailing address
800 E CHEVES ST STE 260, FLORENCE, SC 29506-2652
(843) 665-7941
(843) 665-1257
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
60950347
WA
208600000X
Surgery Physician
Primary
91929
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
919297
—
SC
Enumeration date
06/20/2019
Last updated
07/22/2024
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