Provider Demographics
NPI:1003105255
Name:FOSTER, CLAYTON LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:LEE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-1331 NAWAHIE LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8533
Mailing Address - Country:US
Mailing Address - Phone:205-602-3311
Mailing Address - Fax:720-759-3462
Practice Address - Street 1:78-6831 ALII DR STE 422
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-5402
Practice Address - Country:US
Practice Address - Phone:808-747-8321
Practice Address - Fax:808-322-6005
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054823207R00000X
COCDRH.0054823207RI0200X
CODR.00654823207RI0200X
HIMD-22161207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42132738Medicaid
CO42132738Medicaid