Provider Demographics
NPI:1124108279
Name:FOSTER III, CLARENCE E (MD)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:E
Last Name:FOSTER III
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 23RD AVE N
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1534
Mailing Address - Country:US
Mailing Address - Phone:615-342-5626
Mailing Address - Fax:615-342-5635
Practice Address - Street 1:330 23RD AVE N
Practice Address - Street 2:SUITE 250
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-342-5626
Practice Address - Fax:615-342-5635
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000000C51540204F00000X
TN54678204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC51540BMedicare PIN