Provider Demographics
NPI:1740579945
Name:FENTON, KIRA BROOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:BROOKE
Last Name:FENTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1272 N RIO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1378
Mailing Address - Country:US
Mailing Address - Phone:954-771-0611
Mailing Address - Fax:954-530-6207
Practice Address - Street 1:4701 N FEDERAL HWY STE A21
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-771-0611
Practice Address - Fax:954-491-3930
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine