Healthcare Provider Details

I. General information

NPI: 1922085539
Provider Name (Legal Business Name): WILLIAM FREDERICK FELDNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 NORTH NEW BALLAS ROAD STE 226A
SAINT LOUIS MO
63195-2395
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4900
  • Fax: 314-996-4901
Mailing address:
  • Phone: 314-996-4900
  • Fax: 314-996-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1J82
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberR1J82
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: