Provider Demographics
NPI:1235153321
Name:FEDER, DAVID BENJAMIN (DPM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:FEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3625
Mailing Address - Country:US
Mailing Address - Phone:561-734-3100
Mailing Address - Fax:561-734-7925
Practice Address - Street 1:715 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3625
Practice Address - Country:US
Practice Address - Phone:561-734-3100
Practice Address - Fax:561-734-7925
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO00002353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU45800Medicare UPIN
FL65308ZMedicare ID - Type Unspecified