Healthcare Provider Details

I. General information

NPI: 1891428942
Provider Name (Legal Business Name): CAYLEA FOSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CLARK AVE
SAINT LOUIS MO
63103-2718
US

IV. Provider business mailing address

1402 S GRAND BLVD RM M260
SAINT LOUIS MO
63104-1004
US

V. Phone/Fax

Practice location:
  • Phone: 403-700-4797
  • Fax:
Mailing address:
  • Phone: 314-977-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number2022017583
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: