Healthcare Provider Details

I. General information

NPI: 1073748604
Provider Name (Legal Business Name): THOMAS W FOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-6400
  • Fax: 870-424-1609
Mailing address:
  • Phone: 870-508-6400
  • Fax: 870-424-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD14314
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE8678
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: