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NPI Code Detail

MEDICARE: CLARENCE E. FOGLEMAN III M.D.

MEDICARE: CLARENCE E. FOGLEMAN III 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
1207W00000XOphthalmology Physician27918CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2020006928OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3FO30141OTHERCOBLUE SHIELD

General Provider Information

NPI Number : 1629096243
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARENCE E. FOGLEMAN III M.D.
Provider Business Mailing Address
First Line : 111 E POLK ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-6267
Country : US
Telephone Number : 719-473-8801
Fax Number : 719-473-8581
Provider Business Practice Location Address
First Line : 111 E POLK ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-6267
Country : US
Telephone Number : 719-473-8801
Fax Number : 719-473-8581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 08/10/2012

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