Provider Demographics
NPI:1710988522
Name:FELTER, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:FELTER
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 1:2445 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2842
Mailing Address - Country:US
Mailing Address - Phone:520-458-8131
Mailing Address - Fax:520-458-0422
Practice Address - Street 1:2445 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2842
Practice Address - Country:US
Practice Address - Phone:520-458-8131
Practice Address - Fax:520-458-0422
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19575207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ297988Medicaid
AZ20037Medicare ID - Type Unspecified
E66708Medicare UPIN