Provider Demographics
NPI:1366440315
Name:FOUST, GLENN T III (MD,)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:T
Last Name:FOUST
Suffix:III
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-322-2240
Mailing Address - Fax:303-322-9260
Practice Address - Street 1:2055 HIGH ST
Practice Address - Street 2:#140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-322-2240
Practice Address - Fax:303-322-9260
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01199744Medicaid
NE10025711400Medicaid
WY1366440315Medicaid
KS200739430AMedicaid
COCF3418Medicare ID - Type Unspecified
CO01199744Medicaid
COD23693Medicare UPIN
KS200739430AMedicaid