Healthcare Provider Details

I. General information

NPI: 1033373410
Provider Name (Legal Business Name): JOHN FONTENOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E EGBERT ST
BRIGHTON CO
80601-2475
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-4000
  • Fax: 303-659-9306
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0046182
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: