Individual
BRUCE PAUL FENSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1715 DOUSMAN ST, GREEN BAY, WI 54303-3211
(920) 496-4700
(920) 496-4766
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24153
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30405700
—
WI
Enumeration date
07/14/2006
Last updated
07/30/2008
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