Provider Demographics
NPI:1093040677
Name:FELDMAN, COREY JAY (PA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:JAY
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PA
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 3243
Mailing Address - Street 2:115 15TH AVE
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-3243
Mailing Address - Country:US
Mailing Address - Phone:303-567-2668
Mailing Address - Fax:303-567-4169
Practice Address - Street 1:115 15TH AVE
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452
Practice Address - Country:US
Practice Address - Phone:303-567-2668
Practice Address - Fax:303-567-4169
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2897363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical