Individual
CHARLES EDWARD FONTENOT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1535 W MAIN STREET, VILLE PLATTE, LA 70586
(337) 363-5521
(337) 363-9134
Mailing address
PO DRAWER 510, VILLE PLATTE, LA 70586
(337) 363-5521
(337) 363-9134
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
010529
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101923
—
LA
01
—
5J379
MEDICARE INDIVIDUAL
LA
Enumeration date
06/17/2006
Last updated
07/08/2007
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