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Organization
JONATHAN E FOUNTAIN MD
Active
Organization
JONATHAN E FOUNTAIN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN E FOUNTAIN MD (SOLE OWNER PRACTITIONER)
(850) 626-0400
Entity
Organization
Contact information
Practice address
5976 BERRYHILL RD, MILTON, FL 32570
(850) 626-0400
(850) 626-0204
Mailing address
5976 BERRYHILL RD, MILTON, FL 32570
(850) 626-0400
(850) 626-0204
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50330
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50330
STATE LICENSE
FL
Enumeration date
11/15/2006
Last updated
03/07/2023
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