Provider Demographics
NPI:1134174097
Name:FELDER, ELIZABETH M (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:FELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:TIBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-5159
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:102 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8025
Practice Address - Country:US
Practice Address - Phone:601-261-5159
Practice Address - Fax:601-545-1740
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13567208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2889465OtherUNITED HEALTH CARE
MS4674478OtherAETNA
MS00114923Medicaid
P01353368OtherRAILROAD MEDICARE
MS302I371726Medicare PIN
MS350482YKFFMedicare PIN
MS00114923Medicaid