Individual
LOGAN JACOB FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1500 CITYWEST BLVD STE 300, HOUSTON, TX 77042-2549
(713) 620-4000
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP136242
TX
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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