| John Phil Fontenot, Llc | |
|
1415 7th St Suite K Mamou LA 70554-2269 | |
| (337) 468-5150 | |
| (337) 468-5155 |
| Full Name | John Phil Fontenot, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1415 7th St, Mamou, Louisiana |
| Authorized Official Name and Position | John P Fontenot (OWNER) |
| Authorized Official Contact | 3374685150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John Phil Fontenot, Llc 1415 7th St Suite K Mamou LA 70554-2269 Ph: (337) 468-5150 | John Phil Fontenot, Llc 1415 7th St Suite K Mamou LA 70554-2269 Ph: (337) 468-5150 |
| NPI Number | 1083724538 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083724538 | NPI | - | NPPES |
| 1066125 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 200868 (Louisiana) | Primary |
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