IndividualActive
Glen Fenton
NPI 1144246091 · Neurology with Special Qualifications in Child Neurology Physician · Saint Louis, MO
Provider details
- NPI number
- 1144246091
- Entity type
- Individual
- Primary specialty
- Neurology with Special Qualifications in Child Neurology PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- MD2010-0078 (NM)
Specialties & taxonomies
- Neurology with Special Qualifications in Child Neurology PhysicianPrimary2084N0402XLicense R5H36 (MO)
Allopathic & Osteopathic Physicians
- Neurology with Special Qualifications in Child Neurology Physician2084N0402XLicense MD2010-0078 (NM)
Allopathic & Osteopathic Physicians
Practice location
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone: (314) 577-5338
Fax: (314) 268-6411
Approximate (ZIP-level) locationGet directions
Mailing address
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Registry dates
- Enumerated
- 2006-07-14
- Last updated
- 2021-01-21
- Certified
- 2021-01-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.