Provider Demographics
NPI:1487625364
Name:FOSTER, JOEL D (DPM)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12639 OLD TESSON RD # 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:6 N.W. SYCAMORE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4703
Practice Address - Country:US
Practice Address - Phone:816-246-4222
Practice Address - Fax:816-246-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161864213ES0131X
KS12-00320213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA32774037Medicare PIN
MOW860000OtherMEDICARE ID TYPE 2
MOW86F069OtherMEDICARE ID TYPE 1
P00209482OtherMEDICARE RAILROAD
KS114201OtherMEDICARE ID TYPE 2
MO305899304Medicaid
KSK90A990Medicare PIN
U84402Medicare UPIN