Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | H1081 | TX |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | PT17541 | ND |
NPI | 1003881558 |
---|---|
Provider Name | Dr. Ray Fontenot |
First Address | Beaumont, TX 77701-4664 |
Second Address | Beaumont, TX 77701-4664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128721103 | (05) | TX |
C15642 | (02) | TX |