Individual
DR. EMILY FONTANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
655 W 8TH STREET, JACKSONVILLE, FL 32209
(904) 244-5044
(904) 244-4508
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME99702
FL
2080P0203X
Pediatric Critical Care Medicine Physician
D67938
MD
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
D67938
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003105963A
—
GA
01
—
129EX
BCBS NC
NC
05
—
279794101
—
FL
05
—
415631500
—
MD
05
—
89129EX
—
NC
01
—
930109142
RAILROAD MEDICARE
NC
Enumeration date
08/09/2005
Last updated
03/02/2020
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