Provider Demographics
NPI:1598161820
Name:FELDSTEIN, BRUCE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DAVID
Last Name:FELDSTEIN
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 1:2891 GREER RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3830
Mailing Address - Country:US
Mailing Address - Phone:650-888-9290
Mailing Address - Fax:
Practice Address - Street 1:2891 GREER RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3830
Practice Address - Country:US
Practice Address - Phone:650-888-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine