Healthcare Provider Details

I. General information

NPI: 1679939128
Provider Name (Legal Business Name): FENTON FAMILY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 GRAVOIS BLUFFS BLVD STE B
FENTON MO
63026-7758
US

IV. Provider business mailing address

774 GRAVOIS BLUFFS BLVD
FENTON MO
63026-7758
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7734
  • Fax: 314-590-5922
Mailing address:
  • Phone: 636-685-7804
  • Fax: 314-336-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN R. HASKELL
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 314-205-6444