Organization
JOHN PHIL FONTENOT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P FONTENOT M.D. (OWNER)
(337) 468-5150
Entity
Organization
Contact information
Practice address
1415 7TH ST, SUITE K, MAMOU, LA 70554-2269
(337) 468-5150
(337) 468-5155
Mailing address
1415 7TH ST, SUITE K, MAMOU, LA 70554-2269
(337) 468-5150
(337) 468-5155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200868
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1066125
—
LA
Enumeration date
08/30/2006
Last updated
08/22/2020
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