Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 3812 | OK |
N | 225100000X | Physical Therapist | 3812 | OK |
NPI | 1033194089 |
---|---|
Provider Name | Mr. Brent Foster |
First Address | Claremore, OK 74017-5416 |
Second Address | Claremore, OK 74017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 05/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200083390A | (05) | OK |
200468590A | (05) | OK |