Provider Demographics
NPI:1073543518
Name:FONTAINE, PATRICIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1020 W BROADWAY AVE
Mailing Address - Street 2:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2504
Mailing Address - Country:US
Mailing Address - Phone:612-302-8200
Mailing Address - Fax:612-302-8275
Practice Address - Street 1:1020 W BROADWAY AVE
Practice Address - Street 2:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2504
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MN24058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10000056OtherPREFERRED ONE
MN21783OtherARAZ
MNHP21964OtherHEALTHPARTNERS
MN01-04920OtherMEDICA CHOICE & PRIMARY
MN102650OtherUCARE
MN01-04920OtherMEDICA CHOICE & PRIMARY