Provider Demographics
NPI:1962587196
Name:TIMOTHY FOSTER PH D LLC
Entity type:Organization
Organization Name:TIMOTHY FOSTER PH D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-385-3794
Mailing Address - Street 1:30 N RING AVE
Mailing Address - Street 2:#200
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4224
Mailing Address - Country:US
Mailing Address - Phone:813-784-0247
Mailing Address - Fax:
Practice Address - Street 1:30 N RING AVE
Practice Address - Street 2:#200
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4224
Practice Address - Country:US
Practice Address - Phone:813-784-0247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73592OtherBLUE CROSS BLUE SHIELD
FLAD791Medicare PIN