Healthcare Provider Details

I. General information

NPI: 1669693867
Provider Name (Legal Business Name): COREY G FOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5727
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-3813
  • Fax: 337-439-0214
Mailing address:
  • Phone: 337-312-8258
  • Fax: 331-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number206940
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2008081401
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: