MEDICARE: DR. THOMAS A. FENGER PH.D., P.A.

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	363A00000X	Physician Assistant	423	AK

General Provider Information

NPI Number	:	1699767418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A. FENGER PH.D., P.A.

Provider Business Mailing Address
First Line	:	16839 PARK PLACE ST
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7819
Country	:	US
Telephone Number	:	907-694-3303
Fax Number	:	907-694-4773

Provider Business Practice Location Address
First Line	:	16839 PARK PLACE ST
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7819
Country	:	US
Telephone Number	:	907-694-3303
Fax Number	:	907-694-4773

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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