Healthcare Provider Details

I. General information

NPI: 1407268972
Provider Name (Legal Business Name): STEPHEN FENDER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 N STATE ROAD 7 SUITE 205
MARGATE FL
33063-5715
US

IV. Provider business mailing address

1700 NW 64TH ST
FT LAUDERDALE FL
33309-1800
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-4080
  • Fax: 954-580-4081
Mailing address:
  • Phone: 954-580-4084
  • Fax: 954-530-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: