Organization
SOUTHERN UROLOGY LLC
Active
Other names
Coolidge Location
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD F BREAUX M.D. (MANAGING MEMBER)
(337) 233-6665
Entity
Organization
Contact information
Practice address
1016 COOLIDGE BLVD, LAFAYETTE, LA 70503-2436
(337) 233-6665
(337) 233-0327
Mailing address
PO BOX 54028, LAFAYETTE, LA 70505-4028
(337) 233-6665
(337) 233-0327
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1305308
—
LA
01
—
5DF66
MEDICARE
LA
Enumeration date
07/23/2009
Last updated
01/04/2010
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