Provider Demographics
NPI:1568408516
Name:FOSDICK, CLAUDE CARL III (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:CARL
Last Name:FOSDICK
Suffix:III
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 1:560 N CAMINO MERCADO STE 7
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5759
Mailing Address - Country:US
Mailing Address - Phone:520-836-5538
Mailing Address - Fax:844-772-0049
Practice Address - Street 1:560 N CAMINO MERCADO STE 7
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5759
Practice Address - Country:US
Practice Address - Phone:520-836-5538
Practice Address - Fax:844-772-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0391880OtherBLUE CROSS BLUE SHIELD AZ
AZ13210OtherARIZONA STATE LICENSE
AZ296055Medicaid
AZAZ0391880OtherBLUE CROSS BLUE SHIELD AZ
AZD21508Medicare UPIN
AZZMD13210Medicare ID - Type UnspecifiedMEDICARE