Healthcare Provider Details

I. General information

NPI: 1164527354
Provider Name (Legal Business Name): JAVIER LA FONTAINE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 INWOOD ROAD
DALLAS TX
75390-9132
US

IV. Provider business mailing address

911 CREEK KNL
SAN ANTONIO TX
78253-5365
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-9103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: