Provider Demographics
NPI:1851482830
Name:FREDERICK T FEASTER MD INC
Entity Type:Organization
Organization Name:FREDERICK T FEASTER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:THOMASON
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-822-4729
Mailing Address - Street 1:2200 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3106
Mailing Address - Country:US
Mailing Address - Phone:727-822-4729
Mailing Address - Fax:727-894-5744
Practice Address - Street 1:2200 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3106
Practice Address - Country:US
Practice Address - Phone:727-822-4729
Practice Address - Fax:727-894-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79534207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4409061OtherAETNA
1716568008OtherCIGNA
1716568008OtherCIGNA
4409061OtherAETNA