MEDICARE: MR. JAMES R. FENTON CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	POR61	FL
2	224P00000X	Prosthetist	POR61	FL

General Provider Information

NPI Number	:	1760489868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES R. FENTON CPO

Provider Business Mailing Address
First Line	:	1701 SE HILLMOOR DR C-13
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-337-7378
Fax Number	:	772-337-1742

Provider Business Practice Location Address
First Line	:	1701 SE HILLMOOR DR C-13
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-337-7378
Fax Number	:	772-337-1742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/11/2025

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