Provider Demographics
NPI:1740262047
Name:FEATHERSTONE, BRYAN (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:FEATHERSTONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 ESPLANADE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7234
Mailing Address - Country:US
Mailing Address - Phone:530-345-7699
Mailing Address - Fax:530-345-7677
Practice Address - Street 1:1647 HARTNELL AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2268
Practice Address - Country:US
Practice Address - Phone:530-241-5808
Practice Address - Fax:530-605-1352
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85960Medicare UPIN
CA020A70161Medicare ID - Type Unspecified