Provider Demographics
NPI:1457453722
Name:JOHN W MELTON MD & REED A FONTENOT JR MD APMC
Entity Type:Organization
Organization Name:JOHN W MELTON MD & REED A FONTENOT JR MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-477-8861
Mailing Address - Street 1:2016 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7828
Mailing Address - Country:US
Mailing Address - Phone:337-477-8861
Mailing Address - Fax:337-477-3092
Practice Address - Street 1:2016 DAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7828
Practice Address - Country:US
Practice Address - Phone:337-477-8861
Practice Address - Fax:337-477-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty