Healthcare Provider Details

I. General information

NPI: 1174705446
Provider Name (Legal Business Name): ARTHUR B FONTAINE M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

PO BOX 10296
BAKERSFIELD CA
93389-0296
US

V. Phone/Fax

Practice location:
  • Phone: 661-204-5411
  • Fax: 661-325-1725
Mailing address:
  • Phone: 661-204-5411
  • Fax: 661-325-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG59286
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG59286
License Number StateCA

VIII. Authorized Official

Name: DR. ARTHUR B FONTAINE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 661-204-5411