Individual
JERYL PAUL BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9001 SUMMA AVE, BATON ROUGE, LA 70809-3726
(225) 761-5414
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-5044
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
LA025976
LA
207R00000X
Internal Medicine Physician
Primary
MD.025976
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1049450
—
LA
Enumeration date
06/27/2006
Last updated
04/21/2015
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