Provider Demographics
NPI:1225020845
Name:FONTAINE, ARTHUR B (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:B
Last Name:FONTAINE
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:PO BOX 10296
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0296
Mailing Address - Country:US
Mailing Address - Phone:661-322-9958
Mailing Address - Fax:661-325-1725
Practice Address - Street 1:1250 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:661-204-5411
Practice Address - Fax:661-325-1725
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG592862085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G592860Medicaid
CA00G592861Medicare PIN
CA00G592860Medicaid