Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 2006020968 | MO |
NPI | 1295702314 |
---|---|
Provider Name | Louis Richard Feldenberg |
First Address | St. Louis, MO 63110-2515 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 26/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G01918 | (02) | CA |