Provider Demographics
NPI:1760100127
Name:FOSTER, BRIAN LEE
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
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 1:3330 CALDERA BLVD APT 245
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2848
Mailing Address - Country:US
Mailing Address - Phone:928-951-3266
Mailing Address - Fax:
Practice Address - Street 1:302 SECOR ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6343
Practice Address - Country:US
Practice Address - Phone:432-685-5029
Practice Address - Fax:432-203-1017
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18489208000000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatrics