MEDICARE: STEPHEN G FOSTER PA-C

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	363A00000X	Physician Assistant	6685	GA
2	363AS0400X	Surgical Physician Assistant	PA08811	TX

General Provider Information

NPI Number	:	1992040562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN G FOSTER PA-C

Provider Business Mailing Address
First Line	:	7947 GLADE HILL CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4510
Country	:	US
Telephone Number	:	404-886-8705
Fax Number	:	770-874-5469

Provider Business Practice Location Address
First Line	:	3900 JUNIUS ST STE 705
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1627
Country	:	US
Telephone Number	:	770-732-5500
Fax Number	:

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

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	03/31/2022

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