Individual
BENNETT FONTENOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 E SAINT MARY BLVD STE 104, LAFAYETTE, LA 70503-2378
(337) 504-3640
Mailing address
104 FERNRIDGE DR, LAFAYETTE, LA 70508-5444
(337) 504-6271
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
LL30088
SC
208600000X
Surgery Physician
Primary
MD.205820
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2400541
—
LA
01
—
437739YJRA
PLASTIC AND RECONSTRUCTIVE SURGERY
LA
Enumeration date
06/29/2007
Last updated
03/17/2018
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