Provider Demographics
NPI:1255341251
Name:FOSTER, RICHARD WAYNE
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAYNE
Last Name:FOSTER
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:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-5726
Mailing Address - Fax:985-230-5683
Practice Address - Street 1:1900 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5742
Practice Address - Country:US
Practice Address - Phone:985-230-5726
Practice Address - Fax:985-230-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.015138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00955216Medicaid
300037190OtherRR MEDICARE
LA1352403Medicaid
MS00955216Medicaid
LA1352403Medicaid