Provider Demographics
NPI:1699888784
Name:FOSTER, DANA MARTIN (PA)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:MARTIN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 SANDY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9693
Mailing Address - Country:US
Mailing Address - Phone:979-543-5510
Mailing Address - Fax:979-543-4137
Practice Address - Street 1:305 SANDY CORNER RD
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9693
Practice Address - Country:US
Practice Address - Phone:979-543-5510
Practice Address - Fax:979-543-4137
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant