Provider Demographics
NPI: | 1477143733 |
---|---|
Name: | FELDHAMMER, MATTHEW (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | |
Last Name: | FELDHAMMER |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 655 W 8TH ST # C504 |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32209-6511 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 904-244-5076 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 655 W 8TH ST |
Practice Address - Street 2: | |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32209-6511 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-244-5076 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2021-01-21 |
Last Update Date: | 2021-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DE | 1225 | 246QC1000X |
246QI0000X, 246QL0901X, 246ZB0500X | ||
FL | DL49402 | 247ZC0005X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 247ZC0005X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Clinical Laboratory Director, Non-physician |
No | 246QC1000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Chemistry |
No | 246QI0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Immunology |
No | 246QL0901X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management, Diplomate |
No | 246ZB0500X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Biochemist |