Basic Information
| Provider Information | |||||||||
| NPI: | 1215977335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FENTON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 3RD ST E | ||||||||
| Address2: | |||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079347352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 TRANCAS ST | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945582906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072574014 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A89316 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A893160 | 05 | CA | MEDICAID |