Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01049343A | IN |
NPI | 1003818949 |
---|---|
Provider Name | Mr. Jerrod A Feldman |
First Address | Rochester, IN 46975-8931 |
Second Address | Rochester, IN 46975-8931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200281890A | (05) | IN |
H15866 | (02) | IN |