Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD200548 | LA |
NPI | 1033140637 |
---|---|
Provider Name | Dr. Robert Lepine Fontane |
First Address | Alexandria, LA 71301-3917 |
Second Address | Alexandria, LA 71301-3917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I50033 | (02) | LA |