Provider Demographics
NPI:1558604256
Name:FEIGENBAUM, GARY SLESING (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SLESING
Last Name:FEIGENBAUM
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 1:1250 16TH ST.
Mailing Address - Street 2:SUITE 2304 CENTRAL WING
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-319-4698
Mailing Address - Fax:310-206-3260
Practice Address - Street 1:1250 16TH ST
Practice Address - Street 2:SUITE 2304 CENTRAL WING
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1249
Practice Address - Country:US
Practice Address - Phone:310-319-4698
Practice Address - Fax:310-206-3260
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133392207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGF3232267556OtherUSC