Provider Demographics
NPI:1699767418
Name:FENGER, THOMAS A (PHD, PA)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:FENGER
Suffix:
Gender:M
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16839 PARK PLACE ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7819
Mailing Address - Country:US
Mailing Address - Phone:907-694-3303
Mailing Address - Fax:907-694-4773
Practice Address - Street 1:16839 PARK PLACE ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7819
Practice Address - Country:US
Practice Address - Phone:907-694-3303
Practice Address - Fax:907-694-4773
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant