Provider Demographics
NPI:1770524332
Name:FONTENOT, JAMES BRANDON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRANDON
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 JACK MILLER RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5613
Mailing Address - Country:US
Mailing Address - Phone:337-363-4499
Mailing Address - Fax:337-363-4990
Practice Address - Street 1:421 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5613
Practice Address - Country:US
Practice Address - Phone:337-363-4499
Practice Address - Fax:337-363-4990
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA025984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1049484Medicaid
LA1049484Medicaid
LA4F332Medicare PIN