Provider Demographics
NPI:1205843463
Name:FEITZ, DANIEL E (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:FEITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2239
Mailing Address - Country:US
Mailing Address - Phone:850-784-9787
Mailing Address - Fax:850-784-9619
Practice Address - Street 1:2424 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2239
Practice Address - Country:US
Practice Address - Phone:850-784-9787
Practice Address - Fax:850-784-9619
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2094213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65208ZMedicare ID - Type Unspecified
FLU24943Medicare UPIN