Provider Demographics
NPI:1467593335
Name:FOERSTER, BRUCE V (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:V
Last Name:FOERSTER
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 1:6280 JACKSON DR
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3434
Mailing Address - Country:US
Mailing Address - Phone:619-825-6325
Mailing Address - Fax:619-825-6517
Practice Address - Street 1:6280 JACKSON DR
Practice Address - Street 2:SUITE 4C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3434
Practice Address - Country:US
Practice Address - Phone:619-825-6325
Practice Address - Fax:619-825-6517
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66154207X00000X
CAG 66154207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 66154OtherCALIFORNIA
CAW20586Medicare PIN
CAG 66154OtherCALIFORNIA