Provider Demographics
NPI:1801822044
Name:FONTENOT, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1415 7TH ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2269
Mailing Address - Country:US
Mailing Address - Phone:337-468-5155
Mailing Address - Fax:337-468-5155
Practice Address - Street 1:1415 7TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2269
Practice Address - Country:US
Practice Address - Phone:337-468-5150
Practice Address - Fax:337-468-5155
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066125Medicaid
LAI57011Medicare UPIN
LA1066125Medicaid