Provider Demographics
NPI:1386677748
Name:FELTER, FRED CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:CHARLES
Last Name:FELTER
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:PO BOX 7054
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-0003
Mailing Address - Country:US
Mailing Address - Phone:541-726-1034
Mailing Address - Fax:
Practice Address - Street 1:940 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2208
Practice Address - Country:US
Practice Address - Phone:541-344-2600
Practice Address - Fax:541-344-3317
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR062760Medicaid
ORC92608Medicare UPIN
OR062760Medicaid