Provider Demographics
NPI:1437297942
Name:DALE FEINBERG
Entity Type:Organization
Organization Name:DALE FEINBERG
Other - Org Name:FEINBERG FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-305-0200
Mailing Address - Street 1:1951 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6925
Mailing Address - Country:US
Mailing Address - Phone:928-317-8900
Mailing Address - Fax:928-317-8903
Practice Address - Street 1:11364 S FOOTHILLS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5706
Practice Address - Country:US
Practice Address - Phone:928-305-0200
Practice Address - Fax:928-317-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0278213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0841170003Medicare NSC