Individual
TAYLOR FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1800 21ST AVE S, FARGO, ND 58103-5759
(701) 365-8700
(701) 365-8701
Mailing address
1800 21ST AVE S, FARGO, ND 58103-5759
(701) 365-8700
(701) 364-8701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11875
MN
363A00000X
Physician Assistant
Primary
PAC0603
ND
Other
Enumeration date
07/20/2015
Last updated
03/17/2018
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