Healthcare Provider Details

I. General information

NPI: 1376591016
Provider Name (Legal Business Name): RALPH C FELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W APACHE TRL
APACHE JUNCTION AZ
85220-3728
US

IV. Provider business mailing address

1840 W APACHE TRL
APACHE JUNCTION AZ
85220-3728
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-3500
  • Fax: 480-889-3502
Mailing address:
  • Phone: 480-889-3500
  • Fax: 480-889-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15719
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: