Provider Demographics
NPI:1255359519
Name:FELTS, JEFFREY E (RVT, RDMS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:E
Last Name:FELTS
Suffix:
Gender:M
Credentials:RVT, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 GOLD ST
Mailing Address - Street 2:#100
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6658
Mailing Address - Country:US
Mailing Address - Phone:972-205-1144
Mailing Address - Fax:972-205-1115
Practice Address - Street 1:325 GOLD ST
Practice Address - Street 2:#100
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6658
Practice Address - Country:US
Practice Address - Phone:972-205-1144
Practice Address - Fax:972-205-1115
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7491247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459902OtherBLUE CROSS/ BLUE SHIELD
TXFTVXU9Medicare ID - Type UnspecifiedIDTF
TX459901Medicare ID - Type UnspecifiedPORTABLE X-RAY