Healthcare Provider Details

I. General information

NPI: 1134174097
Provider Name (Legal Business Name): ELIZABETH M FELDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M TIBBS MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MEDICAL PARK
HATTIESBURG MS
39401-8025
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-261-5159
  • Fax: 601-545-1740
Mailing address:
  • Phone: 601-261-5159
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13567
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: