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Individual
BEAU JAMES FENNER
Active
Individual
BEAU JAMES FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD-49725
IA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
MD-49725
IA
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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