Provider Demographics
NPI:1396740577
Name:FENDLEY, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:FENDLEY
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 1:4300 W MAIN ST
Mailing Address - Street 2:STE 24
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-1534
Mailing Address - Fax:334-793-6840
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:STE 24
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-1534
Practice Address - Fax:334-793-6840
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51080734OtherBCBS
AL000080734Medicaid
AL000080734OtherAL BLUECROSS BLUESHIELD #
AL009947330Medicaid
AL51080734OtherBCBS
AL000080734Medicare ID - Type UnspecifiedAL MEDICARE #