Provider Demographics
NPI:1508081944
Name:FOSTER, MATTHEW DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DUANE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2584
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-2584
Mailing Address - Country:US
Mailing Address - Phone:575-625-1237
Mailing Address - Fax:575-624-0805
Practice Address - Street 1:169 MARK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8848
Practice Address - Country:US
Practice Address - Phone:575-317-0218
Practice Address - Fax:575-624-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-178207Q00000X
TXN5678207Q00000X
MT12183207Q00000X
WAMD60289657207Q00000X
IDM-11674207Q00000X
WY8991A207Q00000X
CODR.0051542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD35634Medicare UPIN