Provider Demographics
NPI:1174683379
Name:FELDMAN, GARRY LOUIS (PHD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:LOUIS
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 CURIE DR
Mailing Address - Street 2:STE 204
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2909
Mailing Address - Country:US
Mailing Address - Phone:915-542-0882
Mailing Address - Fax:915-542-0883
Practice Address - Street 1:1733 CURIE DR
Practice Address - Street 2:STE 204
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2909
Practice Address - Country:US
Practice Address - Phone:915-542-0882
Practice Address - Fax:915-542-0883
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOFJ46OtherBCBS