Provider Demographics
NPI:1083630420
Name:STUART M FELDMAN DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STUART M FELDMAN DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-407-2548
Mailing Address - Street 1:PO BOX 33729
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3729
Mailing Address - Country:US
Mailing Address - Phone:702-407-2548
Mailing Address - Fax:702-407-2549
Practice Address - Street 1:8955 S PECOS RD
Practice Address - Street 2:#2-B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7157
Practice Address - Country:US
Practice Address - Phone:702-407-2548
Practice Address - Fax:702-407-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102095Medicaid
NV5047030001Medicare NSC
V37663Medicare ID - Type Unspecified
NV002102095Medicaid