1487657011 NPI number — DR. CARL DOUGLAS FOSTER D.D.S.

Table of content: EMILY PALMER SLP (NPI 1881836617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487657011 NPI number — DR. CARL DOUGLAS FOSTER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
CARL
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1487657011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 S. CAMPBELL ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79901-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-543-3580
Provider Business Mailing Address Fax Number:
915-543-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9314 JUANCITIDO LANE
Provider Second Line Business Practice Location Address:
YSLETA DEL SUR PUEBLO COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-858-1076
Provider Business Practice Location Address Fax Number:
915-858-2367
Provider Enumeration Date:
05/27/2005

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: 1223D0001X , with the licence number:  11802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 11802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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