Provider Demographics
NPI:1033103726
Name:FELDHAUS, JOSEPH L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:FELDHAUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0967
Mailing Address - Country:US
Mailing Address - Phone:325-869-6171
Mailing Address - Fax:325-869-8118
Practice Address - Street 1:506 EAKER
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837-0967
Practice Address - Country:US
Practice Address - Phone:325-869-6171
Practice Address - Fax:325-869-8118
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA04463Medicare UPIN
83M674Medicare PIN