Provider Demographics
NPI:1629094339
Name:FOSTER, LAWRENCE GORDON (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:GORDON
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 1:230 HOSPITAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4563
Mailing Address - Country:US
Mailing Address - Phone:707-463-3501
Mailing Address - Fax:
Practice Address - Street 1:58581 US HIGHWAY 371
Practice Address - Street 2:STE F, G, H
Practice Address - City:ANZA
Practice Address - State:CA
Practice Address - Zip Code:92539-9331
Practice Address - Country:US
Practice Address - Phone:951-763-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34957208600000X
OH35.042130208600000X
WY2534A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A349570Medicaid
CAA27638Medicare UPIN