Healthcare Provider Details

I. General information

NPI: 1003360678
Provider Name (Legal Business Name): ERIC FEIGENBAUM C-AA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 ATRIUM DR
ORLANDO FL
32822-3751
US

IV. Provider business mailing address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

V. Phone/Fax

Practice location:
  • Phone: 618-412-6180
  • Fax:
Mailing address:
  • Phone: 618-412-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: