Provider Demographics
NPI:1225128374
Name:JAMES M. FEENEY MD AND DAVID A VAUGHAN MD, A PARTNERSHIP
Entity Type:Organization
Organization Name:JAMES M. FEENEY MD AND DAVID A VAUGHAN MD, A PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-992-0463
Mailing Address - Street 1:1800 SULLIVAN AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2222
Mailing Address - Country:US
Mailing Address - Phone:650-992-0463
Mailing Address - Fax:650-992-8912
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-992-0463
Practice Address - Fax:650-992-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45181174400000X
CAG51966174400000X
CAA65286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22871ZOtherMEDICARE GROUP NUMBER
CAGR0088110OtherMEDI-CAL PROV ID #
CACI9098OtherMEDICARE RAILROAD PROV #
CAZZZ60314ZOtherBLUE SHIELD PROV #
CAZZZ60314ZOtherBLUE SHIELD PROV #
CA00G451810Medicare ID - Type UnspecifiedJAMES FEENEY MD'S #
CAZZZ22871ZOtherMEDICARE GROUP NUMBER
CAA52134Medicare UPIN
CAA49927Medicare UPIN
CAGR0088110OtherMEDI-CAL PROV ID #