Healthcare Provider Details

I. General information

NPI: 1477510766
Provider Name (Legal Business Name): THEODORE S. FELGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 1001
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

11945 SAN JOSE BLVD BLDG 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-0033
  • Fax: 904-398-6774
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-399-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME42116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: