Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD17106 | TN |
NPI | 1003817115 |
---|---|
Provider Name | Dr. James Daniel Talley |
First Address | Winter Springs, FL 32708-3734 |
Second Address | Orlando, FL 32803-8208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |