Healthcare Provider Details

I. General information

NPI: 1033103106
Provider Name (Legal Business Name): DANIEL B FELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY SUITE 100
PHOENIX AZ
85054-3105
US

IV. Provider business mailing address

18325 N ALLIED WAY SUITE 100
PHOENIX AZ
85054-3105
US

V. Phone/Fax

Practice location:
  • Phone: 602-467-4966
  • Fax: 480-419-5401
Mailing address:
  • Phone: 602-467-4966
  • Fax: 480-419-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: