Organization
FENTON FAMILY PRACTICE, LLC
Active
Organization
FENTON FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDA LYNN BUCKLEY M.D. (DOCTOR)
(636) 529-7000
Entity
Organization
Contact information
Practice address
1747 SMIZER STATION RD, SUITE 5, FENTON, MO 63026-2784
(636) 529-7000
(636) 529-7003
Mailing address
1747 SMIZER STATION RD, SUITE 5, FENTON, MO 63026-2784
(636) 529-7000
(636) 529-7003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
115447
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205692908
—
MO
Enumeration date
01/17/2007
Last updated
09/19/2013
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