Provider Demographics
NPI:1649211277
Name:FONTENOT, JOSEPH LAROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LAROSE
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:600 BEL AIR BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3511
Mailing Address - Country:US
Mailing Address - Phone:251-476-4744
Mailing Address - Fax:251-476-4741
Practice Address - Street 1:600 BEL AIR BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3501
Practice Address - Country:US
Practice Address - Phone:251-476-4744
Practice Address - Fax:251-476-4741
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00006597152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC78072Medicare UPIN