Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN5691 | FL |
NPI | 1144343468 |
---|---|
Provider Name | Dr. Steven Jerrold Feldman |
First Address | Venice, FL 34285-2414 |
Second Address | Venice, FL 34285-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |