Healthcare Provider Details

I. General information

NPI: 1497965974
Provider Name (Legal Business Name): JOSHUA SCOTT FENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

3431 LAKE POINTE
MEMPHIS TN
38125-8842
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-1000
  • Fax:
Mailing address:
  • Phone: 901-748-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number49093
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD437151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: