Healthcare Provider Details

I. General information

NPI: 1447254933
Provider Name (Legal Business Name): JAMES ALAN FOUNTAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8704 N MERIDIAN ST
INDIANAPOLIS IN
46260-2331
US

IV. Provider business mailing address

8704 N MERIDIAN ST
INDIANAPOLIS IN
46260-2331
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-1501
  • Fax: 317-571-4806
Mailing address:
  • Phone: 317-571-1501
  • Fax: 317-571-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01025122A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: