Provider Demographics
NPI:1063718492
Name:JAMES M. FOSS M. D.
Entity type:Organization
Organization Name:JAMES M. FOSS M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:253-531-7722
Mailing Address - Street 1:13410 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4866
Mailing Address - Country:US
Mailing Address - Phone:253-531-7722
Mailing Address - Fax:253-535-3658
Practice Address - Street 1:13410 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4866
Practice Address - Country:US
Practice Address - Phone:253-531-7722
Practice Address - Fax:253-535-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00016278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8898507OtherMEDICARE PTAN
WAG8898507OtherMEDICARE PTAN