Provider Demographics
NPI:1447254933
Name:FOUNTAIN, JAMES ALAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:FOUNTAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8704 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2331
Mailing Address - Country:US
Mailing Address - Phone:317-571-1501
Mailing Address - Fax:317-571-4806
Practice Address - Street 1:8704 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2331
Practice Address - Country:US
Practice Address - Phone:317-571-1501
Practice Address - Fax:317-571-4806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01025122A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN088990AMedicare ID - Type Unspecified
INE12212Medicare UPIN