Provider Demographics
NPI:1194835918
Name:CARR, FOSTER P (MD)
Entity Type:Individual
Prefix:DR
First Name:FOSTER
Middle Name:P
Last Name:CARR
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 1:2534 STATE ST # 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1316
Mailing Address - Country:US
Mailing Address - Phone:877-271-6078
Mailing Address - Fax:877-271-6078
Practice Address - Street 1:2534 STATE ST # 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1316
Practice Address - Country:US
Practice Address - Phone:877-271-6078
Practice Address - Fax:877-271-6078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66933Medicare PIN
CAE47851Medicare UPIN