MEDICARE: BRUCE H FELDMAN 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	207K00000X	Allergy & Immunology Physician	68-16	NM

General Provider Information

NPI Number	:	1871672535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE H FELDMAN MD

Provider Business Mailing Address
First Line	:	4901 LANG AVE NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4597
Country	:	US
Telephone Number	:	505-883-2574
Fax Number	:	505-883-0725

Provider Business Practice Location Address
First Line	:	4901 LANG AVE NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4597
Country	:	US
Telephone Number	:	505-883-2574
Fax Number	:	505-883-0725

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	09/13/2011

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