Healthcare Provider Details

I. General information

NPI: 1164452371
Provider Name (Legal Business Name): DAVID J. FOSCUE, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W CYPRESS ST
WARREN AR
71671-2730
US

IV. Provider business mailing address

113 W CYPRESS ST
WARREN AR
71671-2730
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-2844
  • Fax: 870-226-5200
Mailing address:
  • Phone: 870-226-2844
  • Fax: 870-226-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE0549
License Number StateAR

VIII. Authorized Official

Name: TERESA J FOSCUE
Title or Position: MANAGER
Credential:
Phone: 870-226-2844