MEDICARE: ROBERT FENTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	D6743	TX

General Provider Information

NPI Number	:	1114987013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT FENTON MD

Provider Business Mailing Address
First Line	:	412 S HENDERSON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1017
Country	:	US
Telephone Number	:	817-335-2606
Fax Number	:	817-335-2635

Provider Business Practice Location Address
First Line	:	412 S HENDERSON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1017
Country	:	US
Telephone Number	:	817-335-2606
Fax Number	:	817-335-2635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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