Individual
JASON FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
133 PARK ST, MALONE, NY 12953-1244
(518) 483-3000
Mailing address
PO BOX 459, OPELOUSAS, LA 70571-0459
(337) 943-7128
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
021093
LA
207L00000X
Anesthesiology Physician
Primary
292013
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952117
—
LA
Enumeration date
05/31/2005
Last updated
04/28/2021
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