Individual
JACK FENNEL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
126 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-8952
(573) 329-8305
(573) 329-8302
Mailing address
126 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-8952
(573) 329-8305
(573) 329-8302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R9D28
MO
207QA0505X
Adult Medicine Physician
Primary
R9D28
MO
Other
Enumeration date
03/20/2006
Last updated
09/11/2025
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