Provider Demographics
NPI:1568553022
Name:FELDKAMP, IRVING M IV (MD)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:M
Last Name:FELDKAMP
Suffix:IV
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:PO BOX 10818
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423
Mailing Address - Country:US
Mailing Address - Phone:909-382-0201
Mailing Address - Fax:909-382-0210
Practice Address - Street 1:2777 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1571
Practice Address - Country:US
Practice Address - Phone:562-595-5653
Practice Address - Fax:562-595-4247
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A947500OtherMEDI-CAL