Healthcare Provider Details

I. General information

NPI: 1740272921
Provider Name (Legal Business Name): MARTIN ALAN FELDMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E THUNDERBIRD RD STE 1-3
PHOENIX AZ
85022-5306
US

IV. Provider business mailing address

3620 N 3RD ST
PHOENIX AZ
85012-2020
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-218-6383
Mailing address:
  • Phone: 602-230-7373
  • Fax: 602-230-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2104
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: