Provider Demographics
NPI:1003928060
Name:DARK, FOY EDWARD III (DO)
Entity Type:Individual
Prefix:DR
First Name:FOY
Middle Name:EDWARD
Last Name:DARK
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1201 HEWITT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8833
Mailing Address - Country:US
Mailing Address - Phone:254-666-3627
Mailing Address - Fax:254-732-6125
Practice Address - Street 1:1201 HEWITT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8833
Practice Address - Country:US
Practice Address - Phone:254-666-3627
Practice Address - Fax:243-732-6125
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXTXBL2860207P00000X
TXL2860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2620OtherBC BS OF TX
TX147338106Medicaid
TX920116707OtherRR MCR TX
TX8G2620OtherBC BS OF TX
TX8660B2Medicare ID - Type Unspecified