Provider Demographics
NPI:1356334957
Name:FELDMAN, MARK IRA (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:IRA
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 1:3801 N CAMPBELL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1448
Mailing Address - Country:US
Mailing Address - Phone:520-327-3644
Mailing Address - Fax:520-327-4867
Practice Address - Street 1:3801 N CAMPBELL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1448
Practice Address - Country:US
Practice Address - Phone:520-327-3644
Practice Address - Fax:520-327-4867
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-05-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AZ5756207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281543Medicaid
D36828Medicare UPIN
AZ64012Medicare ID - Type UnspecifiedMEDICARE NUMBER