Provider Demographics
NPI:1164452371
Name:DAVID J. FOSCUE, M.D. PA
Entity type:Organization
Organization Name:DAVID J. FOSCUE, M.D. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOSCUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-226-2844
Mailing Address - Street 1:113 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-2730
Mailing Address - Country:US
Mailing Address - Phone:870-226-2844
Mailing Address - Fax:870-226-5200
Practice Address - Street 1:113 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2730
Practice Address - Country:US
Practice Address - Phone:870-226-2844
Practice Address - Fax:870-226-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1164452371Medicaid
AR127969002Medicaid
AR127887001Medicaid
AR5C433Medicare ID - Type UnspecifiedGROUP
AR127887001Medicaid
AR127969002Medicaid