Individual
ANNIE M FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1020 BANDANA BLVD W, SAINT PAUL, MN 55108-5107
(651) 641-7021
(651) 641-7151
Mailing address
1021 BANDANA BLVD E, SUITE 200, SAINT PAUL, MN 55108-5113
(651) 642-2700
(651) 642-9441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37625
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
786018800
—
MN
Enumeration date
06/30/2006
Last updated
07/08/2007
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