Provider Demographics
NPI:1447350350
Name:FOSTER-WEXLER, STEVEN ARON (LAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ARON
Last Name:FOSTER-WEXLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:ARON
Other - Last Name:WEXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:628 NW YORK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1572
Mailing Address - Country:US
Mailing Address - Phone:541-330-8283
Mailing Address - Fax:541-388-2439
Practice Address - Street 1:628 NW YORK DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1572
Practice Address - Country:US
Practice Address - Phone:541-330-8283
Practice Address - Fax:541-388-2439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500607452Medicaid