Provider Demographics
NPI:1679568380
Name:FOSTER, JOHN WOOD JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WOOD
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-686-6600
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Practice Address - Street 2:STE 261
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5846
Practice Address - Country:US
Practice Address - Phone:432-687-0700
Practice Address - Fax:432-570-0602
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF39632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137278103Medicaid
TX1D5510OtherTX MEDICARE
C15680Medicare UPIN