Healthcare Provider Details

I. General information

NPI: 1841237005
Provider Name (Legal Business Name): CARLA SUE FOSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA SUE CHARBONNEAU M.D.

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 E 12300 S
DRAPER UT
84020-9095
US

IV. Provider business mailing address

PO BOX 1000
DRAPER UT
84020-1000
US

V. Phone/Fax

Practice location:
  • Phone: 801-545-0600
  • Fax: 801-542-0626
Mailing address:
  • Phone: 801-542-8222
  • Fax: 801-542-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number360883-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: