Provider Demographics
NPI:1326228750
Name:STACEY L. FOSHEE, M.D., PC
Entity Type:Organization
Organization Name:STACEY L. FOSHEE, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-6909
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 6110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-272-6909
Mailing Address - Fax:405-231-3783
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 6110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1068
Practice Address - Country:US
Practice Address - Phone:405-272-6909
Practice Address - Fax:405-231-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17560207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45600Medicare UPIN