MEDICARE: DR. JEFFREY STEVEN FELGNER M.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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	A136023	CA

General Provider Information

NPI Number	:	1790122497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY STEVEN FELGNER M.D.

Provider Business Mailing Address
First Line	:	1998 ORANGE AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2238
Country	:	US
Telephone Number	:	858-735-6258
Fax Number	:

Provider Business Practice Location Address
First Line	:	1998 ORANGE AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2238
Country	:	US
Telephone Number	:	858-735-6258
Fax Number	:

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

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	07/15/2021

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