Provider Demographics
NPI:1811927403
Name:FOSTER, RANDALL DWIGHT (OPA-C, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DWIGHT
Last Name:FOSTER
Suffix:
Gender:M
Credentials:OPA-C, ATC, LAT
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Mailing Address - Street 1:122 BYRON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-4602
Mailing Address - Country:US
Mailing Address - Phone:254-592-7329
Mailing Address - Fax:254-968-7979
Practice Address - Street 1:561 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3548
Practice Address - Country:US
Practice Address - Phone:254-965-2663
Practice Address - Fax:254-968-7979
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-01-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT1504OtherATHLETIC TRAINER