Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G32805 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G32805 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G32805 | CA |
NPI | 1780618926 |
---|---|
Provider Name | Robert B Fenton |
First Address | Torrance, CA 90503-5800 |
Second Address | Torrance, CA 90503-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 03/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45294 | (02) | CA |