Provider Demographics
NPI:1871672535
Name:FELDMAN, BRUCE H (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:FELDMAN
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 1:4901 LANG AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4597
Mailing Address - Country:US
Mailing Address - Phone:505-883-2574
Mailing Address - Fax:505-883-0725
Practice Address - Street 1:4901 LANG AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4597
Practice Address - Country:US
Practice Address - Phone:505-883-2574
Practice Address - Fax:505-883-0725
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68-16207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121488Medicare ID - Type Unspecified
NMD35616Medicare UPIN