Basic Information
Provider Information
NPI: 1861442782
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FELDER
FirstName: RANDALL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2656
Address2:  
City: BRYAN
State: TX
PostalCode: 778052656
CountryCode: US
TelephoneNumber: 8063559595
FaxNumber: 8063531589
Practice Location
Address1: 1501 S COULTER ST
Address2:  
City: AMARILLO
State: TX
PostalCode: 791061770
CountryCode: US
TelephoneNumber: 8063541000
FaxNumber: 8063541200
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 04/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XH0338TXY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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