Basic Information
| Provider Information | |||||||||
| NPI: | 1639237043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID E FELDMAN, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930620190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055225940 | ||||||||
| FaxNumber: | 8055226401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907323505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108323311 | ||||||||
| FaxNumber: | 3105145204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | FELDMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3108323311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ50198Z | 01 | BLUE SHIELD | OTHER | GR0103940 | 05 | CA | MEDICAID |