Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 1621 | AL |
NPI | 1780874099 |
---|---|
Provider Name | Mr. Justin D. Foster |
First Address | Mobile, AL 36619-9534 |
Second Address | Mobile, AL 36619-9534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000-75172 | PROVIDER (01) | AL |
U56293 | (02) | AL |