Healthcare Provider Details

I. General information

NPI: 1497819304
Provider Name (Legal Business Name): WILLIAM STANLEY FENTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 HAMILTON MIDDLETOWN RD
HAMILTON OH
45011-2262
US

IV. Provider business mailing address

PO BOX 637676
CINCINNATI OH
45263-7676
US

V. Phone/Fax

Practice location:
  • Phone: 513-863-6222
  • Fax: 513-863-6478
Mailing address:
  • Phone: 513-569-6117
  • Fax: 513-569-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: