MEDICARE: FOSTER DAVID JONES CRNP

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	363L00000X	Nurse Practitioner	1-073567	AL

General Provider Information

NPI Number	:	1093764888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOSTER DAVID JONES CRNP

Provider Business Mailing Address
First Line	:	P O BOX 169
Second Line	:
City	:	PARRISH
State	:	AL
Zip	:	35580-0169
Country	:	US
Telephone Number	:	205-686-5113
Fax Number	:	205-686-5145

Provider Business Practice Location Address
First Line	:	5947 HWY 269
Second Line	:
City	:	PARRISH
State	:	AL
Zip	:	35580-0169
Country	:	US
Telephone Number	:	205-686-5113
Fax Number	:	205-686-5145

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/28/2007

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