MEDICARE: DR. JEFFREY CARL FOSNES 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	174400000X	Specialist	MD14905	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4103229	OTHER	TN	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1487609467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CARL FOSNES M.D.

Provider Business Mailing Address
First Line	:	220 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:	615-598-7633
Fax Number	:	931-762-6532

Provider Business Practice Location Address
First Line	:	220 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:	615-598-7633
Fax Number	:	931-762-6532

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/20/2018

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