Provider Demographics
NPI:1154706596
Name:FOSTER, BRIAN (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-1750
Mailing Address - Fax:406-327-1960
Practice Address - Street 1:3075 N RESERVE ST STE Q
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1390
Practice Address - Country:US
Practice Address - Phone:406-327-1750
Practice Address - Fax:406-327-1960
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44394363A00000X
ORPA174030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant