Provider Demographics
NPI:1508089707
Name:FELDMAN, STUART L (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:L
Last Name:FELDMAN
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 1:1950 SUNNYCREST DR
Mailing Address - Street 2:#3400
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3638
Mailing Address - Country:US
Mailing Address - Phone:714-879-2410
Mailing Address - Fax:714-879-5340
Practice Address - Street 1:1950 SUNNYCREST DR
Practice Address - Street 2:#3400
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-879-2410
Practice Address - Fax:714-879-5340
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41816208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851498133OtherGROUP NPI
CA05D0684380OtherCLIA
CAG41816Medicaid
CAG59971OtherLISCENCE
CA05D0552498OtherCLIA
CAYYY49655YOtherBLUE SHIELD
CA05D0977537OtherCLIA
CAGROO11581Medicaid
CAGROO11581Medicaid
CAWG41816BMedicare PIN
CAG41816Medicaid
CAWG41816CMedicare PIN
CAYYY49655YOtherBLUE SHIELD
CA05D0684380OtherCLIA
CAA48702Medicare UPIN