Fenton Family Practice, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

115447 Issued in MO

Legal business name

FENTON FAMILY PRACTICE, LLC

Practice address

1747 Smizer Station Rd
Suite 5
Fenton, MO 63026-2784

Phone

(636) 529-7000

Fax

(636) 529-7003

NPI assigned

Jan 17, 2007

Last updated

Sep 19, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brenda Lynn Buckley, M.D.

Title

Doctor

Phone

(636) 529-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1356493811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 SMIZER STATION RD",
            "address_2": "SUITE 5",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262784",
            "telephone_number": "636-529-7000",
            "fax_number": "636-529-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 SMIZER STATION RD",
            "address_2": "SUITE 5",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262784",
            "telephone_number": "636-529-7000",
            "fax_number": "636-529-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENTON FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "636-529-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "115447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205692908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fenton Chiropractic and Rehab Center, Inc (Spinal Care of St Louis)
• Fenton Emergency Group LLC
• Fenton Eye Care
• Fenton Family Eyecare, LLC
• Fenton Family Physicians, LLC
• Fenton Fire Protection District
• Fenton Pediatrics, L.L.C.
• Fenton Physical Therapy
• Isabel Fernandez-Holtzman, MD
• Lynn Fey, DC

• Specialist in Fenton, MO
• Providers in Fenton, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.