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General NPI Number Information
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NPI Number | 1104981901
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Entity Type | Organization
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Legal Business Name | WAYNE L. FENTON
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 350 N SAM HOUSTON PKWY E STE 255
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City | HOUSTON
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State | TX
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Zip | 77060-3397
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Country | US
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Telephone | 281-820-9393
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Fax | 281-820-9589
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Provider Business Mailing Address
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Address Line | 350 N SAM HOUSTON PKWY E STE 255
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City | HOUSTON
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State | TX
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Zip | 77060-3397
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Country | US
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Telephone | 281-820-9393
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Fax | 281-820-9589
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Authorized Official
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Title or Position | OWNER
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Name | MR. WAYNE L. FENTON
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Credential | BC-HIS
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Telephone | 281-820-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 50063
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License Number State | TX
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