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NPI Code Detail

MEDICARE: MR. TED MARSHALL FELDMAN PA-C

MEDICARE: MR. TED MARSHALL FELDMAN PA-C
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
1363AS0400XSurgical Physician AssistantPA113062FL
2363AS0400XSurgical Physician AssistantMA002553-LPA
3363A00000XPhysician AssistantPA113062FL

General Provider Information

NPI Number : 1407945256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TED MARSHALL FELDMAN PA-C
Provider Business Mailing Address
First Line : 1050 SE MONTEREY RD STE 400
Second Line :
City : STUART
State : FL
Zip : 34994-4512
Country : US
Telephone Number : 772-288-2400
Fax Number :
Provider Business Practice Location Address
First Line : 9401 SW DISCOVERY WAY STE 101
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-2381
Country : US
Telephone Number : 772-288-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 10/26/2020

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