Provider Demographics
NPI:1659403764
Name:FOSTER, ROBERT STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R.
Other - Middle Name:STEVE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1715 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7541
Mailing Address - Country:US
Mailing Address - Phone:660-826-7077
Mailing Address - Fax:660-826-4202
Practice Address - Street 1:1715 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7541
Practice Address - Country:US
Practice Address - Phone:660-826-7077
Practice Address - Fax:660-826-4202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D16208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10470061OtherBCBSKC
MOE43712Medicare UPIN
MOF106465Medicare PIN
MO0861170001Medicare NSC