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General NPI Number Information
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NPI Number | 1033183264
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Entity Type | Individual
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Provider Name | MICHAEL EDWIN FENTON MD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 643 CHALAN SAN ANTONIO STE 109
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City | TAMUNING
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State | GU
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Zip | 96913-3644
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Country | US
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Telephone | 671-648-6390
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Fax |
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Provider Business Mailing Address
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Address Line | 5251 TITLE ROW DR
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City | BRADENTON
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State | FL
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Zip | 34210-4058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-1810
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License Number State | GU
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 00022516
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License Number State | AL
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