Provider Demographics
NPI:1972626273
Name:FOSTER, LAWRENCE HUNT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HUNT
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 TAHOE KEYS BLVD
Mailing Address - Street 2:E-6
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-3360
Mailing Address - Country:US
Mailing Address - Phone:530-541-3355
Mailing Address - Fax:530-541-0110
Practice Address - Street 1:589 TAHOE KEYS BLVD
Practice Address - Street 2:E-6
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3360
Practice Address - Country:US
Practice Address - Phone:530-541-3355
Practice Address - Fax:530-541-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 19345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist