Provider Demographics
NPI:1376768309
Name:FEATHERSTONE, HARVEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:FEATHERSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-0667
Mailing Address - Country:US
Mailing Address - Phone:575-354-1515
Mailing Address - Fax:575-354-1815
Practice Address - Street 1:517 HIGHWAY 380
Practice Address - Street 2:CHRIST COMMUNITY FELLOWSHIP CHURCH
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316
Practice Address - Country:US
Practice Address - Phone:575-354-1515
Practice Address - Fax:575-354-1815
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31655Medicaid
A04461Medicare UPIN