Healthcare Provider Details

I. General information

NPI: 1548252018
Provider Name (Legal Business Name): PAULA M FOUST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N SWALLOWTAIL DR ST. 102B
PORT ORANGE FL
32129-6102
US

IV. Provider business mailing address

900 N SWALLOWTAIL DR ST. 102B
PORT ORANGE FL
32129-6102
US

V. Phone/Fax

Practice location:
  • Phone: 386-492-6929
  • Fax: 386-492-6930
Mailing address:
  • Phone: 386-492-6929
  • Fax: 386-492-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME97528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: