Individual
MICHAEL S FONTENOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1331 BANDERA HWY STE 10, KERRVILLE, TX 78028-9535
(830) 257-1440
(830) 257-2542
Mailing address
1331 BANDERA HWY STE 10, KERRVILLE, TX 78028-9535
(830) 257-1440
(830) 257-2542
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J5761
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085EY
BCBS
TX
01
—
106116
SUPERIOR CHIP
TX
05
—
130580703
—
TX
Enumeration date
08/10/2005
Last updated
04/14/2011
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