Healthcare Provider Details

I. General information

NPI: 1669463600
Provider Name (Legal Business Name): TOMMY GENE FOSTER JR. LICENSED ORTHOTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 HIGHWAY 280 S SUITE 141
MOUNTAIN BROOK AL
35223-2466
US

IV. Provider business mailing address

2737 HIGHWAY 280 S SUITE 141
MOUNTAIN BROOK AL
35223-2466
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-9961
  • Fax: 205-870-9908
Mailing address:
  • Phone: 205-870-9961
  • Fax: 205-870-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number151
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: