Healthcare Provider Details

I. General information

NPI: 1346217817
Provider Name (Legal Business Name): PAUL FELDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 EADS AVE
LA JOLLA CA
92037-5456
US

IV. Provider business mailing address

7222 EADS AVE
LA JOLLA CA
92037-5456
US

V. Phone/Fax

Practice location:
  • Phone: 617-281-4279
  • Fax:
Mailing address:
  • Phone: 617-281-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA24743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: