Healthcare Provider Details

I. General information

NPI: 1336309616
Provider Name (Legal Business Name): BRENT A FELDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7163
  • Fax:
Mailing address:
  • Phone: 707-423-7163
  • Fax: 707-423-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA130651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: