Provider Demographics
NPI:1508959388
Name:FOSTER, JEFFREY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:FOSTER
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 1:9362 TOLLGATE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9300
Mailing Address - Country:US
Mailing Address - Phone:303-442-2269
Mailing Address - Fax:303-444-0253
Practice Address - Street 1:9362 TOLLGATE DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9300
Practice Address - Country:US
Practice Address - Phone:303-442-2269
Practice Address - Fax:303-444-0253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1088002084P0800X
CO463512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004646457OtherAETNA ID#
NYJF06443010OtherEMPIRE BLUE SHIELD #
NY0089662OtherGHI PROVIDER ID#
NY00192618Medicaid
NY108800OtherMEDICAL LICENSE
CO46351OtherMEDICAL LICENSE
NYNS3637OtherOXFORD HEALTH PLANS ID#
NY108800OtherHIP PROVIDER #
NYJF06443010OtherEMPIRE BLUE SHIELD #
NY0089662OtherGHI PROVIDER ID#