Provider Demographics
NPI:1225004658
Name:FELTNER, ROLAND V (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:V
Last Name:FELTNER
Suffix:
Gender:M
Credentials:MD
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 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 BICKFORD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1749
Practice Address - Country:US
Practice Address - Phone:360-568-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005239Medicaid
WAG8901130Medicare PIN
A09326Medicare UPIN
WA1005239Medicaid
8887650Medicare PIN