Healthcare Provider Details

I. General information

NPI: 1629502455
Provider Name (Legal Business Name): TIMOTHY PAUL FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD COM, DEPT OF PEDIATRICS, MEDICAL EDUCATION
GAINESVILLE FL
32610-0196
US

IV. Provider business mailing address

PO BOX 100296 COM, DEPT OF PEDIATRICS, MEDICAL EDUCATION
GAINESVILLE FL
32610-0196
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8234
  • Fax: 352-294-8060
Mailing address:
  • Phone: 352-273-8234
  • Fax: 352-294-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME144730
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME144730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: