Provider Demographics
NPI:1417515859
Name:FOSTER, DOMINIQUE CHRISTINE BRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:CHRISTINE BRADY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W 24TH ST UNIT 10
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1802
Mailing Address - Country:US
Mailing Address - Phone:806-293-5113
Mailing Address - Fax:
Practice Address - Street 1:2222 W 24TH ST UNIT 10
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1802
Practice Address - Country:US
Practice Address - Phone:806-293-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT8206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program