Provider Demographics
NPI:1235521337
Name:FOGGER, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:FOGGER
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 1:526 STABLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3291
Mailing Address - Country:US
Mailing Address - Phone:318-228-7526
Mailing Address - Fax:
Practice Address - Street 1:8TH MDG
Practice Address - Street 2:UNIT 2022, KUNSAN
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96264
Practice Address - Country:US
Practice Address - Phone:315-782-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine