Healthcare Provider Details

I. General information

NPI: 1003928060
Provider Name (Legal Business Name): FOY EDWARD DARK III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HEWITT DR SUITE 203
WACO TX
76712-8833
US

IV. Provider business mailing address

1201 HEWITT DR SUITE 203
WACO TX
76712-8833
US

V. Phone/Fax

Practice location:
  • Phone: 254-666-3627
  • Fax: 243-732-6125
Mailing address:
  • Phone: 254-666-3627
  • Fax: 254-732-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTXBL2860
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2860
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: