Provider Demographics
NPI:1558318816
Name:FENTON, DARREL THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:THOMAS
Last Name:FENTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S 8TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4560
Mailing Address - Country:US
Mailing Address - Phone:970-522-2264
Mailing Address - Fax:970-522-2272
Practice Address - Street 1:1405 S 8TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4563
Practice Address - Country:US
Practice Address - Phone:970-522-2264
Practice Address - Fax:970-522-2272
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30576207X00000X
MOR7B34207X00000X
NE105207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41517Medicare UPIN
C808121Medicare PIN