Provider Demographics
NPI:1528352291
Name:FOUST, PAYTON BLAIR (MD)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:BLAIR
Last Name:FOUST
Suffix:
Gender:M
Credentials:MD
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-926-6820
Mailing Address - Fax:
Practice Address - Street 1:3799 12TH STREET EXTENSION
Practice Address - Street 2:STE 105
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033
Practice Address - Country:US
Practice Address - Phone:803-926-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine