MEDICARE: DR. DAVID A FENYES M.D.,PH.D.

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	2085R0202X	Diagnostic Radiology Physician	L6885	TX
2	2085B0100X	Body Imaging Physician	L6885	TX
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	L6885	TX
4	2085U0001X	Diagnostic Ultrasound Physician	L6885	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184627994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A FENYES M.D.,PH.D.

Provider Business Mailing Address
First Line	:	816 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3146
Country	:	US
Telephone Number	:	817-321-0312
Fax Number	:	817-317-7033

Provider Business Practice Location Address
First Line	:	815 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2224
Country	:	US
Telephone Number	:	817-321-0312
Fax Number	:	817-317-7033

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/14/2012

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