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General NPI Number Information
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NPI Number | 1912917337
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Entity Type | Individual
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Provider Name | TOM R FONTENOT D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5541 E PARKWAY ST
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City | GROVES
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State | TX
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Zip | 77619-2935
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Country | US
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Telephone | 409-960-6300
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Fax | 409-960-6363
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Provider Business Mailing Address
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Address Line | 5541 E PARKWAY ST
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City | GROVES
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State | TX
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Zip | 77619-2935
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Country | US
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Telephone | 409-960-6300
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Fax | 409-960-6363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 7909
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License Number State | TX
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