Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD17523 | OR |
NPI | 1003809666 |
---|---|
Provider Name | Dr. Steven R Foutz |
First Address | Central Point, OR 97502-1573 |
Second Address | Grants Pass, OR 97526-1267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027768 | (05) | OR |
E25385 | (02) | OR |