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General NPI Number Information
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NPI Number | 1497705891
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Entity Type | Individual
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Provider Name | ELTON G. FENNELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 415 W COLUMBIA ST STE 110
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City | EVANSVILLE
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State | IN
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Zip | 47710-1656
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Country | US
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Telephone | 812-450-3363
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Fax | 812-450-3071
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Provider Business Mailing Address
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Address Line | PO BOX 3407
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City | EVANSVILLE
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State | IN
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Zip | 47733-3407
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Country | US
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Telephone | 812-450-3363
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Fax | 812-450-3071
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01074892A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 45090
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01074892A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 235209
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License Number State | MA
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