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Individual

DARRYL FONTAINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4105 FORT HENRY DRIVE, SUITE 207, KINGSPORT, TN 37663
(423) 239-5833
(423) 239-9789
Mailing address
1 FONTAINE CT, KINGSPORT, TN 37660
(423) 392-4981
(423) 245-5032

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20124
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00013859
NHC CARE ADMINISTRATORS
05
0221312000
WV
01
063263
ANTHEM BCBS
01
100011235
PHP TENNCARE
01
3046989
BLUE SHIELD OF TN
05
3051034
TN
05
5747040
VA
05
64911142
KY
05
890576L
NC
01
TN0100
JOHN DEERE
Enumeration date
08/22/2005
Last updated
07/08/2007
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