Healthcare Provider Details

I. General information

NPI: 1245336353
Provider Name (Legal Business Name): KEVIN L.FOSTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEDICAL DR SUITE 400
WENTZVILLE MO
63385-3654
US

IV. Provider business mailing address

801 MEDICAL DR SUITE 400
WENTZVILLE MO
63385-3654
US

V. Phone/Fax

Practice location:
  • Phone: 636-327-3100
  • Fax: 636-639-5132
Mailing address:
  • Phone: 636-327-3100
  • Fax: 636-639-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROY FOSTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-327-3100