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Individual
DR. LARRY L FONTANILLA JR.
Active
Individual
DR. LARRY L FONTANILLA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00043682
WA
207R00000X
Internal Medicine Physician
MD00043682
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191058
WA L & I
—
01
—
2537FO
REGENCE BS
—
05
—
8396830
—
WA
01
—
8939281
WA CRIME VICTIMS
—
01
—
H39247
GROUP HEALTH
—
01
—
P00234764
RAILROAD MEDICARE
—
Enumeration date
06/09/2006
Last updated
11/27/2007
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