Provider Demographics
NPI:1124107453
Name:FEIST, FREDRIC WARREN SR (MD)
Entity type:Individual
Prefix:MR
First Name:FREDRIC
Middle Name:WARREN
Last Name:FEIST
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-2214
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:256-494-5536
Practice Address - Street 1:425 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2214
Practice Address - Country:US
Practice Address - Phone:256-492-7800
Practice Address - Fax:256-494-5536
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000002083Medicaid
51502083OtherBLUE CROSS OF ALABAMA
51002083OtherBLUE CROSS OF ALABAMA