Individual provider Active NPI

Ray Fontenot, M.D.

  • Otolaryngology Physician
  • Minot, ND
National Provider Identifier
1003881558
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
H1081 Issued in TX
Practice address
101 3Rd Ave SW
Minot, ND 58701-3880
Phone
(701) 857-5986
Fax
(701) 857-5029
NPI assigned
Feb 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 17541 ND
Otolaryngology Physician 207Y00000X PT17541 ND
Otolaryngology Physician 207Y00000X H1081 TX Primary

Addresses

Primary practice location

101 3Rd Ave SW
Minot, ND 58701-3880

Mailing address

101 3Rd Ave SW
Minot, ND 58701-3880

Other practice location 1

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 857-5000

Other identifiers 1

IdentifierTypeStateIssuer
128721103MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100407000272 TX Practitioner - Otolaryngology 9931235629 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17541NDMDOtolaryngology Physician
H1081TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Texas Ear, Nose & Throat, LLP Otolaryngology CurrentSince Dec 3, 1986 Accepting new patients

Locations

740 Hospital Dr
Ste 300
Beaumont, TX 77701
Phone (409) 212-8111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1003881558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 3RD AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 3RD AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013880",
            "telephone_number": "701-857-5986",
            "fax_number": "701-857-5029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONTENOT",
        "first_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ND",
            "license": "17541",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ND",
            "license": "PT17541",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "H1081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128721103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.