Provider Demographics
NPI:1972730315
Name:FOSTER UROLOGY CLINIC
Entity Type:Organization
Organization Name:FOSTER UROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:530-751-4730
Mailing Address - Street 1:370 DEL NORTE AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4142
Mailing Address - Country:US
Mailing Address - Phone:530-751-4730
Mailing Address - Fax:530-751-4793
Practice Address - Street 1:370 DEL NORTE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4142
Practice Address - Country:US
Practice Address - Phone:530-751-4730
Practice Address - Fax:530-751-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60284208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty