Healthcare Provider Details

I. General information

NPI: 1053653394
Provider Name (Legal Business Name): MARK THOMAS FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 11/28/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-4000
  • Fax:
Mailing address:
  • Phone: 210-358-0572
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS2774
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number278356
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberS2774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: