Provider Demographics
NPI:1225458797
Name:FONTENOT, GREGORY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:207 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-4448
Mailing Address - Country:US
Mailing Address - Phone:337-898-9449
Mailing Address - Fax:337-898-9556
Practice Address - Street 1:207 MILTON RD
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-4448
Practice Address - Country:US
Practice Address - Phone:337-898-9449
Practice Address - Fax:337-898-9556
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.208146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine