Provider Demographics
NPI:1194805416
Name:FELDMAN, ROBERT GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GABRIEL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:SUITE 333
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-452-1930
Mailing Address - Fax:949-452-0301
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 429
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3685
Practice Address - Country:US
Practice Address - Phone:949-452-1930
Practice Address - Fax:949-452-0301
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68484207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18214Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER