Basic Information
| Provider Information | |||||||||
| NPI: | 1528352291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOUST | ||||||||
| FirstName: | PAYTON | ||||||||
| MiddleName: | BLAIR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6069 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291716069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039266820 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3799 12TH STREET EXTENSION | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CAYCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039266820 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33590 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.