Provider Demographics
NPI:1457796617
Name:FONTENOT, REBEKAH DENISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:DENISE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-0050
Mailing Address - Country:US
Mailing Address - Phone:281-910-7172
Mailing Address - Fax:281-503-7812
Practice Address - Street 1:15003 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4375
Practice Address - Country:US
Practice Address - Phone:281-910-7172
Practice Address - Fax:281-503-7812
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2189213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01770658OtherRAILROAD MEDICARE
TXP02029593OtherRR MEDICARE PTAN
TX365966608Medicaid
TX8JC567OtherBCBS TX
TX365966602Medicaid
TX365966603Medicaid
TX365966601Medicaid
TX365966605Medicaid
TX365966604Medicaid
TX365966601Medicaid
TX548081ZXABMedicare PIN