Individual
JACK LEROY FOSTER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 E 1ST ST STE 404, DULUTH, MN 55805-2265
(218) 722-5513
Mailing address
1000 E 1ST ST STE 404, DULUTH, MN 55805-2265
(218) 722-5513
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
15708
MN
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/27/2024
Last updated
05/08/2026
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