GLEN FENTON (NPI# 1144246091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144246091 |
| Entity Type | Individual |
| Full Name | GLEN FENTON |
| Practice Address |
1402 S Grand Blvd Saint Louis MO 63104-1004 |
| Mailing Address |
1438 S Grand Blvd Saint Louis MO 63104-1027 |
| Practice Telephone | 3145775338 |
| Practice Fax Number | 3142686411 |
| Mailing Telephone | 3149774866 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2017-03-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
R5H36 | MO | Allopathic & Osteopathic Physicians |
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
MD2010-0078 | NM | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
R5H36 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
1402 S GRAND BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63104-1004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588649271 | Fred W Rottnek | Family Medicine | 1402 S Grand Blvd, Family and Community Medicine, Saint Louis, MO 63104-1004 | 2005-12-14 |
| 1891305819 | Ahmed Eltarras | Internal Medicine | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-08-04 |
| 1265058309 | Anu Rijal | Pathology | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-06-24 |
| 1760005706 | Mehmet Tamer | Internal Medicine | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-05-26 |
| 1275156523 | Muhammad Murtaza Alam | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-05-21 |
| 1235758442 | Ryan Walde | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-04-09 |
| 1770148876 | David Starr | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2019-05-03 |
| 1932763703 | Kate Beatriz Alemann | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2019-04-27 |
| 1144783648 | Jakob Hockman | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2019-04-11 |
| 1518426485 | Matthew K Kaili | Student in an Organized Health Care Education/Training Program | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2019-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1023638038 | Laura Ann Humphrey | Physician Assistant | Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 | 2020-04-20 |
| 1174187264 | Ahsan Ali | Student in an Organized Health Care Education/Training Program | 1438 South Grand Blvd, Monteleone Hall, St. Louis, MO 63104 | 2019-04-24 |
| 1205359916 | Brenda Eve Ladin | Behavior Technician | 1221 Allen Market Lane Rear, St. Louis, MO 63104 | 2017-07-25 |
| 1841722063 | Gustavo G Mendez | Student in an Organized Health Care Education/Training Program | 1465 South Grand Bulevard Rm 2717, Ssm Health Cardinal Glennon Children's Hospital, Saint Louis, MO 63104 | 2017-03-28 |
| 1053776716 | Carmella Harper | Respiratory Therapist, Certified | 2678 Park Ave, St Louis, MO 63104 | 2015-12-23 |
| 1922485986 | Alexander Tremont | Internal Medicine | 1402 S Grand Blvd Rm M260, Saint Louis, MO 63104 | 2015-04-29 |
| 1306233341 | Healthcare R Us | Home Health | 2859 Sidney St, St Louis, MO 63104 | 2015-04-16 |
| 1396159091 | Daniela Hermelin | Pathology | 1402 South Grane, St. Louis, MO 63104 | 2014-06-20 |
| 1992117881 | Kelly Denise Durbin | Social Worker | 1920 S 7th St, Saint Louis, MO 63104 | 2014-05-27 |
| Find all providers in zip 63104 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356478705 | Robin Chanel Ryther | Psychiatry & Neurology | 1 Childrens Pl Ste D, Ste D, Saint Louis, MO 63110-1002 | 2007-02-27 |
| 1538542329 | Benjamin Paul Kay | Psychiatry & Neurology | 1 Barnes Jewish Hospital Plz, 1st Fl, Pediatric Neurology, Saint Louis, MO 63110-1003 | 2015-06-30 |
| 1023499001 | Regina Lindsay Triplett | Psychiatry & Neurology | 1 Childrens Pl, 3s34, Saint Louis, MO 63110-1002 | 2015-06-15 |
| 1881034866 | Shannon Christine Agner | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-07-05 |
| 1497195960 | Oleg V Lobanov | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-06-28 |
| 1497199640 | Keisuke Ueda | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-04-18 |
| 1821353756 | Bhooma Rajagopalan Aravamuthan | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2012-07-06 |
| 1437413598 | Jennifer Lynn Griffith | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2012-07-03 |
| 1215291653 | Robert John Rudock II | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2012-06-29 |
| 1184980716 | Ali Ayman Jamal | Psychiatry & Neurology | 1465 S Grand Blvd, Room 1204, Saint Louis, MO 63104 | 2012-04-09 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.