Healthcare Provider Details

I. General information

NPI: 1730195702
Provider Name (Legal Business Name): DAVID FOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE #200
STAYTON OR
97383-1311
US

IV. Provider business mailing address

1401 N 10TH AVE #200
STAYTON OR
97383-1311
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-6367
  • Fax: 503-769-5416
Mailing address:
  • Phone: 503-769-6367
  • Fax: 503-769-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD12438
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: