Provider Demographics
NPI:1891081006
Name:FOOSE, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:FOOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4584 ADOBE RD
Mailing Address - Street 2:SPACE 1
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-1671
Mailing Address - Country:US
Mailing Address - Phone:469-323-4411
Mailing Address - Fax:888-343-3730
Practice Address - Street 1:4584 ADOBE RD
Practice Address - Street 2:SPACE 1
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-1671
Practice Address - Country:US
Practice Address - Phone:469-323-4411
Practice Address - Fax:888-343-3730
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment