| Fenton Family Physicians, Llc | |
|
774 Gravois Bluffs Blvd Ste B Fenton MO 63026-7758 | |
| (636) 685-7734 | |
| (314) 590-5922 |
| Full Name | Fenton Family Physicians, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 774 Gravois Bluffs Blvd Ste B, Fenton, Missouri |
| Authorized Official Name and Position | James Snider (VP PHYSICIAN NETWORK) |
| Authorized Official Contact | 6366857840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fenton Family Physicians, Llc 774 Gravois Bluffs Blvd Fenton MO 63026-7758 Ph: (636) 685-7804 | Fenton Family Physicians, Llc 774 Gravois Bluffs Blvd Ste B Fenton MO 63026-7758 Ph: (636) 685-7734 |
| NPI Number | 1679939128 |
|---|---|
| Provider Enumeration Date | 01/13/2016 |
| Last Update Date | 04/06/2021 |
| Medicare PECOS PAC ID | 5799084091 |
|---|---|
| Medicare Enrollment ID | O20160506001655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679939128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Barbara A Obrien |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437211794 PECOS PAC ID: 4688573389 Enrollment ID: I20031231000671 |
| Provider Name | Kristina A Potts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356747513 PECOS PAC ID: 2961710363 Enrollment ID: I20151005002442 |
| Provider Name | Abigail Anne Lukens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588014658 PECOS PAC ID: 6103259833 Enrollment ID: I20191210002283 |
| Provider Name | Bryan Duepner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861912826 PECOS PAC ID: 1456620830 Enrollment ID: I20200721004041 |
| Provider Name | Annamarie Elizabeth Goldstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093235970 PECOS PAC ID: 0547539926 Enrollment ID: I20200722003335 |
| Provider Name | Ashlyn Patterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285295873 PECOS PAC ID: 5496080442 Enrollment ID: I20220713002380 |
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