Provider Demographics
NPI:1821026626
Name:FOSTER, BARNEY BAILEY (PAC)
Entity Type:Individual
Prefix:
First Name:BARNEY
Middle Name:BAILEY
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 HIGHWAY 95
Mailing Address - Street 2:SUITE G73
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7860
Mailing Address - Country:US
Mailing Address - Phone:928-758-7700
Mailing Address - Fax:928-758-5700
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE G73
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7860
Practice Address - Country:US
Practice Address - Phone:928-758-7700
Practice Address - Fax:928-758-5700
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR15868Medicare UPIN
AZ62743Medicare ID - Type UnspecifiedFOSTER MEDICARE NUMBER