Individual
MR. DUSTIN ALLEN FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
970 HESTERS CROSSING RD, SUITE 101, ROUND ROCK, TX 78681-8027
(512) 238-0762
(512) 341-7370
Mailing address
970 HESTERS CROSSING RD, SUITE 101, ROUND ROCK, TX 78681-8027
(512) 238-0762
(512) 341-7370
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05398
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y4033
BCBS/TX
TX
01
—
PA05398
TEXAS STATE LICENSE
TX
Enumeration date
11/06/2007
Last updated
04/10/2015
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