Healthcare Provider Details

I. General information

NPI: 1255386694
Provider Name (Legal Business Name): CRAIG STEVEN FENDLER CRAIG FENDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: CRAIG STEVEN FENDLER CRAIG FENDLER CT

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD ANATOMIC PATHOLOGY JC-113
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD ANATOMIC PATHOLOGY JC-113
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-289-7073
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-289-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QC2700X
TaxonomyCytotechnology Specialist/Technologist
License NumberCT008339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: