Provider Demographics
NPI:1922090919
Name:FEUERMAN, NEAL E (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:E
Last Name:FEUERMAN
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 1:4343 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:HYDESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95547-9407
Mailing Address - Country:US
Mailing Address - Phone:707-768-9000
Mailing Address - Fax:707-768-9001
Practice Address - Street 1:3300 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3120
Practice Address - Country:US
Practice Address - Phone:707-725-7327
Practice Address - Fax:707-725-7252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76284207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G762840Medicaid
CA00G762840Medicaid
00G762840Medicare ID - Type Unspecified