Provider Demographics
NPI:1548333685
Name:FONT, FREDERICK J A (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J A
Last Name:FONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 SW 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-5721
Mailing Address - Country:US
Mailing Address - Phone:787-409-7138
Mailing Address - Fax:
Practice Address - Street 1:4700 SHERIDAN ST STE C
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-961-3252
Practice Address - Fax:954-678-3007
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6003207RR0500X
FL130497207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D66171OtherBC
602297OtherMMM
602287OtherMMM
29213F0OtherTRICARE
D66171OtherBC
602297OtherMMM
29213F0OtherTRICARE