# CHARLES E. FONTENOT, M.D., A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407964349
- **Authorized official:** DR. CHARLES EDWARD FONTENOT M.D. (PRESIDENT)
- **Authorized official phone:** (337) 363-5521

## Contact information

- **Practice address:** 1535 W MAIN ST, VILLE PLATTE, LA 70586-2867
- **Practice address phone:** (337) 363-5521
- **Practice address fax:** (337) 363-9134
- **Mailing address:** PO BOX 510, VILLE PLATTE, LA 70586-0510
- **Mailing address phone:** (337) 363-5521
- **Mailing address fax:** (337) 363-9134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD010529 | LA | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1101923 | — | LA |
| 01 | — | 4376284200 | BLUE CROSS | LA |