Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0027631 | CO |
N | 207QA0505X | Family Doctor - Adult Medicine | 27631 | CO |
NPI | 1114038403 |
---|---|
Provider Name | Dr. Mark Dewitt Talmage |
First Address | Littleton, CO 80161-3728 |
Second Address | Vona, CO 80861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27631 | STATE LICENSE (01) | CO |
E57562 | (02) |