Individual
HERBERT JERREL FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1275 GLENWOOD DR, WEST MONROE, LA 71291-5539
(318) 322-1339
Mailing address
PO BOX 678308, DALLAS, TX 75267-8308
(800) 897-6169
(601) 936-0686
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
018863
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00119325
MEDICARE RAILROAD
LA
05
—
P00119325
—
LA
Enumeration date
08/23/2006
Last updated
03/06/2012
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