1083739122 NPI number — CARY DON FOSTER C.S.T.

Table of content: CARY DON FOSTER C.S.T. (NPI 1083739122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083739122 NPI number — CARY DON FOSTER C.S.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
CARY
Provider Middle Name:
DON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.S.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083739122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 961205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76161-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-740-8400
Provider Business Mailing Address Fax Number:
817-332-4465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 W. ROSEDALE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-335-4316
Provider Business Practice Location Address Fax Number:
817-332-4465
Provider Enumeration Date:
03/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  CERT. # 080257 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)