Provider Demographics
NPI:1245228550
Name:FOREMAN, KIM ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:ALAN
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130189
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0189
Mailing Address - Country:US
Mailing Address - Phone:903-939-7551
Mailing Address - Fax:903-592-6906
Practice Address - Street 1:8101 S BROADWAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5469
Practice Address - Country:US
Practice Address - Phone:903-561-2495
Practice Address - Fax:800-848-0426
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9435207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine