MEDICARE: DR. BARRY JAY FENTON M.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	2084P0800X	Psychiatry Physician	G1005	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	:	1417082892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY JAY FENTON M.D.

Provider Business Mailing Address
First Line	:	3417 GASTON AVE STE 815
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2034
Country	:	US
Telephone Number	:	214-520-7575
Fax Number	:	214-520-7579

Provider Business Practice Location Address
First Line	:	3417 GASTON AVE STE 815
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2034
Country	:	US
Telephone Number	:	214-520-7575
Fax Number	:	214-520-7579

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	01/21/2025

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