Individual
ERIC FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 381-2484
Mailing address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 381-2484
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
M14950
ID
207RX0202X
Medical Oncology Physician
M14950
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2013
Last updated
03/24/2020
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