MEDICARE: DR. JEFFREY S FELTER MD

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	207W00000X	Ophthalmology Physician	19575	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710988522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY S FELTER MD

Provider Business Mailing Address
First Line	:	2445 E WILCOX DR
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-2842
Country	:	US
Telephone Number	:	520-458-8131
Fax Number	:	520-458-0422

Provider Business Practice Location Address
First Line	:	2445 E WILCOX DR
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-2842
Country	:	US
Telephone Number	:	520-458-8131
Fax Number	:	520-458-0422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/07/2010

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