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NPI Code Detail

MEDICARE: JASON FONTENOT M.D.

MEDICARE: JASON FONTENOT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician021093LA
2207L00000XAnesthesiology Physician292013NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982607255
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON FONTENOT M.D.
Provider Business Mailing Address
First Line : PO BOX 459
Second Line :
City : OPELOUSAS
State : LA
Zip : 70571-0459
Country : US
Telephone Number : 337-943-7128
Fax Number :
Provider Business Practice Location Address
First Line : 133 PARK ST
Second Line :
City : MALONE
State : NY
Zip : 12953-1244
Country : US
Telephone Number : 518-483-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 04/28/2021

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Directions to “ JASON FONTENOT M.D.” Practice Location

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