Healthcare Provider Details

I. General information

NPI: 1740256213
Provider Name (Legal Business Name): LARRY D FOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SIOUX POINT RD SUITE 100
DAKOTA DUNES SD
57049
US

IV. Provider business mailing address

705 SIOUX POINT RD SUITE 100
DAKOTA DUNES SD
57049
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-5500
  • Fax: 605-217-5515
Mailing address:
  • Phone: 605-217-5500
  • Fax: 605-217-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1699
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: