Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D10743 | MN |
NPI | 1033117551 |
---|---|
Provider Name | Dr. Jeffrey Paul Foster |
First Address | Minnetonka, MN 55305-5175 |
Second Address | Minnetonka, MN 55305-5175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
471527262 | DELTA OF MINNESOTA (01) | MN |
637214700 | (05) | MN |
7B016FO | BCBS OF MN (01) | MN |
839878 | UNITED CONCORDIA MILITARY (01) | PA |
U52345 | (02) | MN |