Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 9027 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9027 | KY |
NPI | 1962474304 |
---|---|
Provider Name | Dr. Michael David Foster |
First Address | Kingsport, TN 37660-3799 |
Second Address | Kingsport, TN 37660-3799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 13/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000184655 | BCBS PIN # (01) | KY |
9500101200 | (05) | KY |
970014810 | RR MCARE (01) | KY |
P15769 | (02) | KY |