Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC7285 | TX |
Y | 213ER0200X | Radiology | DC7285 | TX |
NPI | 1336369206 |
---|---|
Provider Name | Carlos Foster |
First Address | Fort Worth, TX 76103-3836 |
Second Address | Fort Worth, TX 76103-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |