Healthcare Provider Details

I. General information

NPI: 1124830583
Provider Name (Legal Business Name): ALEX OSBORNE FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 S GUY LN UNIT 21
IVINS UT
84738-6501
US

IV. Provider business mailing address

687 S GUY LN UNIT 21
IVINS UT
84738-6501
US

V. Phone/Fax

Practice location:
  • Phone: 801-618-6695
  • Fax:
Mailing address:
  • Phone: 801-618-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: