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Individual
DR. JACK T FENDLEY
Active
Individual
DR. JACK T FENDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C4596
AR
207QA0505X
Adult Medicine Physician
C4596
AR
207QG0300X
Geriatric Medicine (Family Medicine) Physician
C4596
AR
207R00000X
Internal Medicine Physician
Primary
C4596
AR
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
C4596
AR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
C4596
AR
Other
Enumeration date
12/15/2005
Last updated
03/23/2018
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