MEDICARE: DR. JOSEPH MICHAEL FEAGAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	328128	LA
2	207Q00000X	Family Medicine Physician	25MB07815200	NJ
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MB07815200	NJ
4	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A-1549-10	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457381394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL FEAGAN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 6210
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87499-6210
Country	:	US
Telephone Number	:	505-609-2258
Fax Number	:	505-609-2259

Provider Business Practice Location Address
First Line	:	1135 S MAIN ST
Second Line	:	SUITE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2946
Country	:	US
Telephone Number	:	575-525-4000
Fax Number	:	575-525-4040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/04/2022

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Directions to “ DR. JOSEPH MICHAEL FEAGAN D.O.” Practice Location

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