Provider Demographics
NPI:1437228657
Name:FONTENOT, ERIC PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:PAUL
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1219 COOLIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2620
Mailing Address - Country:US
Mailing Address - Phone:337-233-4980
Mailing Address - Fax:337-233-4980
Practice Address - Street 1:1219 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2620
Practice Address - Country:US
Practice Address - Phone:337-233-4980
Practice Address - Fax:337-233-4980
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066117Medicaid
LA4K371CN33Medicare PIN
LA4K371Medicare PIN
LA4K371C822Medicare PIN