Provider Demographics
NPI:1437143179
Name:FOSS, FRED M (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:M
Last Name:FOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:948 STEVENS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3547
Mailing Address - Country:US
Mailing Address - Phone:509-946-5150
Mailing Address - Fax:509-946-6547
Practice Address - Street 1:948 STEVENS DR
Practice Address - Street 2:SUITE A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3547
Practice Address - Country:US
Practice Address - Phone:509-946-5150
Practice Address - Fax:509-946-6547
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2009-02-27
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Provider Licenses
StateLicense IDTaxonomies
WAMD00021421208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1018563Medicaid
WAA06078Medicare UPIN
WA0994410001Medicare NSC
WA1018563Medicaid