MEDICARE: GARY M. FEINBERG, MD, FACS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G58691	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730187881	OTHER	AR	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1366557910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY M. FEINBERG, MD, FACS, INC.

Provider Business Mailing Address
First Line	:	6950 BROCKTON AVE
Second Line	:	SUITE 3
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3831
Country	:	US
Telephone Number	:	951-788-1447
Fax Number	:	951-788-1485

Provider Business Practice Location Address
First Line	:	6950 BROCKTON AVE
Second Line	:	SUITE 3
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3831
Country	:	US
Telephone Number	:	951-788-1447
Fax Number	:	951-788-1485

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. GARY MITCHELL FEINBERG
Credential	:	M.D.
Telephone Number	:	951-788-1447

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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