Provider Demographics
NPI:1689669657
Name:FENSTER, HAROLD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ALAN
Last Name:FENSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 H 3/4 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1708
Mailing Address - Country:US
Mailing Address - Phone:970-210-8374
Mailing Address - Fax:
Practice Address - Street 1:2630 H 3/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1708
Practice Address - Country:US
Practice Address - Phone:970-210-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43196208600000X
VA0101031242208600000X
WA32706208600000X
MO20070342312086S0127X
FLME101176208600000X
ORMD27245208600000X
NMMD2006-0680208600000X
IDM-10254208600000X
NH13283208600000X
RIMD12439208600000X
WY7764A208600000X
MT11670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1127305299OtherBNDD
NMCS00212339OtherSTATE CONTROLLED SUBSTANCE REGISTRATION
MOFF0651441OtherDEA
AF2874255OtherDEA NUMBER
CO804751Medicare ID - Type Unspecified
AF2874255OtherDEA NUMBER