Provider Demographics
NPI:1518963883
Name:FELDMAN, MOISES (MD)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
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 1:21230 NE 23RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1012
Mailing Address - Country:US
Mailing Address - Phone:786-916-6363
Mailing Address - Fax:305-459-1930
Practice Address - Street 1:21230 NE 23RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1012
Practice Address - Country:US
Practice Address - Phone:786-916-6363
Practice Address - Fax:305-459-1930
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53502207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063142600Medicaid
FL063142600Medicaid
FLE49332Medicare UPIN