Provider Demographics
NPI:1013913755
Name:FONTAINE, JAMES DONALD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4765 CARMEL MOUNTAIN RD
Mailing Address - Street 2:207B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6657
Mailing Address - Country:US
Mailing Address - Phone:858-876-1300
Mailing Address - Fax:
Practice Address - Street 1:4765 CARMEL MOUNTAIN RD
Practice Address - Street 2:207B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6657
Practice Address - Country:US
Practice Address - Phone:858-876-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72697208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F84091Medicare UPIN