Provider Demographics
NPI:1780687848
Name:FELDMAN, ANDREW C (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:FELDMAN
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 1:800 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3256
Mailing Address - Country:US
Mailing Address - Phone:386-736-4912
Mailing Address - Fax:386-738-0016
Practice Address - Street 1:800 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3256
Practice Address - Country:US
Practice Address - Phone:386-736-4912
Practice Address - Fax:386-738-0016
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077901600Medicaid
FL077901600Medicaid
FL82848CMedicare ID - Type Unspecified