Healthcare Provider Details

I. General information

NPI: 1851896633
Provider Name (Legal Business Name): FRANCISCO RODRIGUEZ FONTAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

IV. Provider business mailing address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax:
Mailing address:
  • Phone: 360-736-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD.MD.70000097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: