Provider Demographics
NPI:1992932388
Name:FEAZELL, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:FEAZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2825 SANTA MONICA BLVD
Mailing Address - Street 2:STE. 104
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2429
Mailing Address - Country:US
Mailing Address - Phone:310-829-9935
Mailing Address - Fax:310-829-1077
Practice Address - Street 1:2825 SANTA MONICA BLVD
Practice Address - Street 2:STE. 104
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2429
Practice Address - Country:US
Practice Address - Phone:310-829-9935
Practice Address - Fax:310-829-1077
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA115519208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992932388Medicaid
CAGH569YMedicare PIN
CAGH569ZMedicare PIN