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General NPI Number Information
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NPI Number | 1700883022
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Entity Type | Individual
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Provider Name | GARY JOSEPH FELSBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1030 SHADOWMOSS CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-4440
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Country | US
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Telephone | 407-716-5344
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Fax | 954-698-6963
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Provider Business Mailing Address
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Address Line | 629A E HILLSBORO BLVD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-3517
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Country | US
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Telephone | 954-698-9399
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Fax | 954-698-6963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME65003
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME65003
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License Number State | FL
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