Organization
ERIC FONTENOT MD INTERNAL MEDICINE GROUP L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC PAUL FONTENOT M.D. (OWNER)
(337) 468-2822
Entity
Organization
Contact information
Practice address
1415 7TH ST, SUITE H, MAMOU, LA 70554-2269
(337) 468-2822
(337) 468-2845
Mailing address
1415 7TH ST, SUITE H, MAMOU, LA 70554-2269
(337) 468-2822
(337) 468-2845
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
201186
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1066117
—
LA
01
—
4337168900
BCBS
LA
Enumeration date
01/30/2007
Last updated
08/22/2020
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