Provider Demographics
NPI:1801960992
Name:FELTS, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:FELTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:910 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2904
Practice Address - Country:US
Practice Address - Phone:573-364-4226
Practice Address - Fax:573-364-5093
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3B37207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201801107Medicaid
MOA10188Medicare UPIN
MO201801107Medicaid