Provider Demographics
NPI:1760489868
Name:FENTON, JAMES R (CPO)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:FENTON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SE HILLMOOR DR C-13
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-337-7378
Mailing Address - Fax:772-337-1742
Practice Address - Street 1:1701 SE HILLMOOR DR C-13
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-337-7378
Practice Address - Fax:772-337-1742
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR61222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1226360001Medicare ID - Type Unspecified