Fenwick, Jeffrey Richard

Fenwick, Jeffrey Richard is an individual health care provider with primary practice located at 960 E Walnut Lawn St Suite 102, Springfield MO 65807-7506. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Fenwick, Jeffrey Richard can be contacted via phone (417) 875-3600.

Contact Information

Primary practice address
960 E Walnut Lawn St Suite 102 Springfield MO 65807-7506
Phone: (417) 875-3600
Fax: (417) 875-3612
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 15294 South Carolina
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 2005041177 Missouri

Profile Details

NPI number 1306846407
LBN Legal business name Fenwick, Jeffrey Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Dec 27th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306846407 NPPES
South Carolina MEDICAID 152998
South Carolina MEDICAID 200282606

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