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General NPI Number Information
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NPI Number | 1215147426
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Entity Type | Organization
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Legal Business Name | KENNETH W. FOSTER, MD, PC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 604 DEWEY AVE
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City | POTEAU
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State | OK
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Zip | 74953-4218
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Country | US
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Telephone | 918-647-8420
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Fax | 918-649-0824
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Provider Business Mailing Address
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Address Line | PO BOX 1041
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City | POTEAU
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State | OK
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Zip | 74953-1041
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Country | US
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Telephone | 918-647-8420
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Fax | 918-649-0824
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH W FOSTER
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Credential | MD
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Telephone | 918-647-8420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 15885
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License Number State | OK
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