Healthcare Provider Details

I. General information

NPI: 1366409930
Provider Name (Legal Business Name): DAVID J FOSCUE M.D. , PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 W PERSIMMON ST
ROGERS AR
72756-3359
US

IV. Provider business mailing address

513 N SHILOH ST
SPRINGDALE AR
72764-3343
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-7192
  • Fax: 479-621-9749
Mailing address:
  • Phone: 479-419-9902
  • Fax: 479-419-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-0549
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: