Provider Demographics
NPI:1568685758
Name:FELDMAN, STUART M (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:M
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 S PECOS RD
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7156
Mailing Address - Country:US
Mailing Address - Phone:702-407-2548
Mailing Address - Fax:702-407-2549
Practice Address - Street 1:8955 S PECOS RD
Practice Address - Street 2:SUITE 2-B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7156
Practice Address - Country:US
Practice Address - Phone:702-407-2548
Practice Address - Fax:702-407-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102095Medicaid
NV002102095Medicaid
NVV37663Medicare ID - Type UnspecifiedMEDICARE NUMBER