Provider Demographics
NPI:1174058663
Name:FOSTER, GLADYS (MT)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:6820 NW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4016
Mailing Address - Country:US
Mailing Address - Phone:405-210-6257
Mailing Address - Fax:
Practice Address - Street 1:6820 NW 31ST TER
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4016
Practice Address - Country:US
Practice Address - Phone:405-210-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246QL0900X
OK246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management