Provider Demographics
NPI:1386667145
Name:FEUERMAN, TONY FRAZER (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:FRAZER
Last Name:FEUERMAN
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 1:16133 VENTURA BLVD
Mailing Address - Street 2:STE. 1105
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2403
Mailing Address - Country:US
Mailing Address - Phone:818-905-9642
Mailing Address - Fax:818-905-7428
Practice Address - Street 1:16133 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 1105
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-905-9642
Practice Address - Fax:818-905-7428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist