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General NPI Number Information
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NPI Number | 1083895288
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Entity Type | Organization
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Legal Business Name | PETER R FENWICK, MD
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 75 PRINGLE WAY STE 505
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City | RENO
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State | NV
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Zip | 89502-1469
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Country | US
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Telephone | 775-786-7216
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Fax | 775-786-9365
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Provider Business Mailing Address
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Address Line | 75 PRINGLE WAY STE 505
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City | RENO
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State | NV
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Zip | 89502-1469
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Country | US
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Telephone | 775-786-7216
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Fax | 775-786-9365
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. PETER R FENWICK
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Credential | MD
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Telephone | 775-786-7216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4024
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License Number State | NV
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