Provider Demographics
NPI:1245437524
Name:FENTON, AMBER STURGES (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:STURGES
Last Name:FENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:STURGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11111 RESEARCH BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5264
Mailing Address - Country:US
Mailing Address - Phone:513-324-6755
Mailing Address - Fax:512-324-6753
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:STE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:512-324-6755
Practice Address - Fax:512-324-6753
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL30107202C00000X
IN1069533207W00000X
TXQ9809207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301079Medicaid
SC301079Medicaid
SC5912Medicare PIN
SC5910Medicare PIN
SC5911Medicare PIN