1508959388 NPI number — JEFFREY ROBERT FOSTER MD

Table of content: JEFFREY ROBERT FOSTER MD (NPI 1508959388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508959388 NPI number — JEFFREY ROBERT FOSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
JEFFREY
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1508959388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9362 TOLLGATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80503-9300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-442-2269
Provider Business Mailing Address Fax Number:
303-444-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9362 TOLLGATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80503-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-442-2269
Provider Business Practice Location Address Fax Number:
303-444-0253
Provider Enumeration Date:
10/02/2006

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: 2084P0800X , with the licence number:  108800 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 46351 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0004646457 . This is a "AETNA ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: JF06443010 . This is a "EMPIRE BLUE SHIELD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0089662 . This is a "GHI PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00192618 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108800 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46351 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: NS3637 . This is a "OXFORD HEALTH PLANS ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 108800 . This is a "HIP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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