Provider Demographics
NPI:1720390552
Name:FOSTER, DAVID R (MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5800
Mailing Address - Country:US
Mailing Address - Phone:660-826-2380
Mailing Address - Fax:660-827-6277
Practice Address - Street 1:121 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5800
Practice Address - Country:US
Practice Address - Phone:660-826-2380
Practice Address - Fax:660-827-6277
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01722103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist