Basic Information
| Provider Information | |||||||||
| NPI: | 1467471193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 E 1ST AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034693182 | ||||||||
| FaxNumber: | 3034694693 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 E 1ST AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034693182 | ||||||||
| FaxNumber: | 3034694693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD25376 | OR | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 52436 | GA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | 052436 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00211626 | 01 | OR | RAILROAD MEDICARE | OTHER | A063 | 01 | OR | TRICARE | OTHER | 277815 | 05 | OR | MEDICAID |