Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 26040 | CO |
NPI | 1003842717 |
---|---|
Provider Name | Laura L Feldman |
First Address | Colorado Springs, CO 80906-3896 |
Second Address | Colorado Springs, CO 80906-3896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01260405 | (05) | CO |
26040 | STATE LICENSE (01) | CO |
26102846 | (05) | CO |
AF2686054 | DEA # (01) | |
E58270 | (02) |