Basic Information
| Provider Information | |||||||||
| NPI: | 1447235577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1032 MAR WALT DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508633463 | ||||||||
| FaxNumber: | 8503156051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1032 MAR WALT DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508633463 | ||||||||
| FaxNumber: | 8503156051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME82193 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 262265300 | 05 | FL | MEDICAID | P00750207 | 01 | FL | MEDICARE RAILROAD | OTHER |