Healthcare Provider Details

I. General information

NPI: 1912943747
Provider Name (Legal Business Name): JAMES FOSTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NE 23RD ST
OKLAHOMA CITY OK
73111-3324
US

IV. Provider business mailing address

PO BOX 659506 SECTION 4142
SAN ANTONIO TX
78265-9506
US

V. Phone/Fax

Practice location:
  • Phone: 405-280-5550
  • Fax: 405-280-5780
Mailing address:
  • Phone: 405-280-5550
  • Fax: 405-280-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: