MEDICARE: DR. MARY FOSCUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	33552	FL

General Provider Information

NPI Number	:	1063967073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY FOSCUE M.D.

Provider Business Mailing Address
First Line	:	1601 E HEINBERG ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32502-4301
Country	:	US
Telephone Number	:	850-304-3997
Fax Number	:	850-304-3997

Provider Business Practice Location Address
First Line	:	1601 E HEINBERG ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32502-4301
Country	:	US
Telephone Number	:	850-304-3997
Fax Number	:	850-304-3997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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