Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35062570 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35062570 | OH |
NPI | 1003820234 |
---|---|
Provider Name | Paul Fenton |
First Address | Ottawa Hills, OH 43615-2318 |
Second Address | Toledo, OH 43615-2068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0265449 | (05) | OH |
F69832 | (02) | OH |