Basic Information
| Provider Information | |||||||||
| NPI: | 1689772816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FENNER | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 DRESSLER RD NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304934443 | ||||||||
| FaxNumber: | 3304938677 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022555123 | ||||||||
| FaxNumber: | 7022555053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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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 | 4650 | NV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 4650 | NV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.