Individual
CARTER PAGE FENTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15740 S OUTER 40 RD, CHESTERFIELD, MO 63017-2004
(636) 735-4205
Mailing address
15740 S OUTER 40 RD, CHESTERFIELD, MO 63017-2004
(636) 735-4205
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20111052
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190050155
CPIN ST ANTHONYS
—
05
—
245164207
—
MO
01
—
930110488
RAILROAD
—
Enumeration date
09/27/2006
Last updated
03/28/2018
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