Basic Information
| Provider Information | |||||||||
| NPI: | 1740272921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022307373 | ||||||||
| FaxNumber: | 6022305105 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E THUNDERBIRD RD STE 1-3 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850225306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022307373 | ||||||||
| FaxNumber: | 6022186383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2104 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 860676047 | 01 | AZ | TAX ID | OTHER | 1072107 | 01 | AZ | CIGNA | OTHER | 4240133 | 01 | AZ | AETNA | OTHER | AZ0062880 | 01 | AZ | BCBS OF AZ | OTHER | 22072104 | 01 | AZ | ICA | OTHER | 0179654 | 01 | AZ | DEPT OF LABOR & INDUSTRIE | OTHER | 1Z8791 | 01 | AZ | HEALTHNET | OTHER | 265711 | 05 | AZ | MEDICAID |