MEDICARE: DR. JOSEPH ROBERT FEIST PH.D.

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	103TC0700X	Clinical Psychologist	PY2188	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74340	OTHER	FL	BLUE CROSS BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number	:	1770887564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ROBERT FEIST PH.D.

Provider Business Mailing Address
First Line	:	4649 PONCE DE LEON BLVD
Second Line	:	SUITE 302
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2114
Country	:	US
Telephone Number	:	305-667-1768
Fax Number	:	305-667-1288

Provider Business Practice Location Address
First Line	:	4649 PONCE DE LEON BLVD
Second Line	:	SUITE 302
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2114
Country	:	US
Telephone Number	:	305-667-1768
Fax Number	:	305-667-1288

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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