Provider Demographics
NPI:1972726446
Name:FENTON, CARTER P SR (DO)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:P
Last Name:FENTON
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1002
Mailing Address - Country:US
Mailing Address - Phone:573-887-3688
Mailing Address - Fax:573-887-9022
Practice Address - Street 1:206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1002
Practice Address - Country:US
Practice Address - Phone:573-887-3688
Practice Address - Fax:573-887-9022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine