Healthcare Provider Details

I. General information

NPI: 1639168479
Provider Name (Legal Business Name): MARK JAMES FOSTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 E MAIN ST
CORTEZ CO
81321-3039
US

IV. Provider business mailing address

2577 MAIN AVE
DURANGO CO
81301-5919
US

V. Phone/Fax

Practice location:
  • Phone: 970-516-5500
  • Fax: 970-516-2500
Mailing address:
  • Phone: 970-505-2100
  • Fax: 970-828-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1467
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: