Healthcare Provider Details

I. General information

NPI: 1801960992
Provider Name (Legal Business Name): JAMES A. FELTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 10TH ST
ROLLA MO
65401-2904
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-4226
  • Fax: 573-364-5093
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3B37
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: