Provider Demographics
NPI:1922085539
Name:FELDNER, WILLIAM FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:FELDNER
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-467-1500
Mailing Address - Fax:314-467-1515
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:ST FRANCIS BLDG., SUITE 450
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:314-467-1500
Practice Address - Fax:314-467-1515
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J82207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205157803Medicaid
MO205157811Medicaid
MO205157803Medicaid
MO124510102Medicare PIN
MO010013298Medicare ID - Type UnspecifiedINSTITUTE