Healthcare Provider Details

I. General information

NPI: 1720074990
Provider Name (Legal Business Name): SHERWIN S. FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1986 W HAYDEN AVE
HAYDEN ID
83835-7412
US

IV. Provider business mailing address

1986 W HAYDEN AVE
HAYDEN ID
83835-7412
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-7760
  • Fax: 208-762-7740
Mailing address:
  • Phone: 208-762-7760
  • Fax: 208-762-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM-10094
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00049028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: