Provider Demographics
NPI:1720160005
Name:FELSHER, BERTRAM FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:FREDERICK
Last Name:FELSHER
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:PO BOX 3626
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90711-3626
Mailing Address - Country:US
Mailing Address - Phone:562-461-8584
Mailing Address - Fax:562-529-7800
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-461-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A206770Medicaid
CA00A206770Medicaid
A20677Medicare ID - Type Unspecified