Provider Demographics
NPI:1063511640
Name:FONTENOT, JAMES T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SAWDUST RD
Mailing Address - Street 2:STE 180
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2929
Mailing Address - Country:US
Mailing Address - Phone:281-292-7411
Mailing Address - Fax:281-292-7481
Practice Address - Street 1:17434 RED OAK DR.
Practice Address - Street 2:STE # C-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1246
Practice Address - Country:US
Practice Address - Phone:281-444-0123
Practice Address - Fax:281-893-4807
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000AF835Medicaid
TXC15644Medicare UPIN
TX00AF83Medicare PIN