Fenton Family Practice, LLC

NPI #1356493811 in Fenton, Missouri

Provider Information

NPI Number: 1356493811
Entity Type: Organization
Organization Name: Fenton Family Practice, LLC
Primary Specialty: Specialist
Enumeration Date: Jan 17, 2007
Last Updated: Sep 19, 2013

Practice Location

Address: 1747 SMIZER STATION RD
Address 2: SUITE 5
City: Fenton
State: Missouri
ZIP Code: 63026-2784
Phone: (636) 529-7000

Authorized Official

Name: DR. BRENDA LYNN BUCKLEY, M.D.
Title: DOCTOR
Phone: (636) 529-7000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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