Provider Demographics
NPI:1235181058
Name:FEEBACK, DANIEL WILLIAM (IDC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:FEEBACK
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 SHORELINE CIR APT 118
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2165
Mailing Address - Country:US
Mailing Address - Phone:757-469-9642
Mailing Address - Fax:
Practice Address - Street 1:667 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - Street 2:MEDICAL DEPARTMENT(CODE NO2M)
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2419
Practice Address - Country:US
Practice Address - Phone:757-443-0026
Practice Address - Fax:757-443-5706
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710I1002XOtherINDEPENDENT DUTY CORPSMAN