Provider Demographics
NPI:1326132572
Name:FOSTER, ALLEN RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:RICARDO
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-0542
Mailing Address - Country:US
Mailing Address - Phone:423-318-0097
Mailing Address - Fax:423-318-7682
Practice Address - Street 1:222 BOWMAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3856
Practice Address - Country:US
Practice Address - Phone:423-318-0097
Practice Address - Fax:423-318-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31234207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3860854Medicaid
TN3860854Medicaid
TNF57742Medicare UPIN