Provider Demographics
NPI:1891061693
Name:FONTE, ELPIDIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELPIDIO
Middle Name:
Last Name:FONTE
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 1:2210 E ILLINOIS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2184
Mailing Address - Country:US
Mailing Address - Phone:559-266-2496
Mailing Address - Fax:559-266-8560
Practice Address - Street 1:2210 E ILLINOIS AVE STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2184
Practice Address - Country:US
Practice Address - Phone:559-266-2496
Practice Address - Fax:559-266-8560
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38327208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice