Provider Demographics
NPI:1851350227
Name:FELDTMAN, ROBERT WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WARREN
Last Name:FELDTMAN
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 1:221 W. COLORADO SUITE 625
Mailing Address - Street 2:DFW VASCULAR LLP
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-946-5165
Mailing Address - Fax:
Practice Address - Street 1:221 W. COLORADO SUITE 625
Practice Address - Street 2:DFW VASCULAR LLP
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-946-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE94982086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1313835-08OtherCSHCN
TXP00105588OtherRR/MEDICARE
TX1313835-07Medicaid
TX8J9878OtherBLUE SHIELD
TX1313835-07Medicaid
TXB22670Medicare UPIN