Provider Demographics
NPI:1245123124
Name:BREAUX MEDICAL, PC
Entity type:Organization
Organization Name:BREAUX MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ELLISON
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:510-384-2846
Mailing Address - Street 1:5960 MCANDREW DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3135
Mailing Address - Country:US
Mailing Address - Phone:510-384-2846
Mailing Address - Fax:
Practice Address - Street 1:5960 MCANDREW DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-3135
Practice Address - Country:US
Practice Address - Phone:510-384-2846
Practice Address - Fax:510-279-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty