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NPI Code Detail

MEDICARE: THOMAS G. FONTENOT, MD

MEDICARE: THOMAS G. FONTENOT, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1154671733
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMAS G. FONTENOT, MD
Provider Business Mailing Address
First Line : 417 EAST LINCOLN ROAD
Second Line :
City : VILLE PLATTE
State : LA
Zip : 70586-3431
Country : US
Telephone Number : 337-363-7744
Fax Number :
Provider Business Practice Location Address
First Line : 417 EAST LINCOLN ROAD
Second Line :
City : VILLE PLATTE
State : LA
Zip : 70586-3431
Country : US
Telephone Number : 337-363-7744
Fax Number :
Authorized Official
Title or Position : OWNER
Name : THOMAS G FONTENOT
Credential : M.D.
Telephone Number : 337-363-7744
Provider Enumeration Date : 09/11/2012
Last Update Date : 09/11/2012

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