Provider Demographics
NPI:1720006687
Name:FENN, PAUL E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:FENN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 PATRIOT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8520
Mailing Address - Country:US
Mailing Address - Phone:337-534-0653
Mailing Address - Fax:337-534-0658
Practice Address - Street 1:105 PATRIOT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-534-0653
Practice Address - Fax:337-534-0658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-06-07
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Provider Licenses
StateLicense IDTaxonomies
LAMD.200825207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI37944Medicare UPIN