Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 49308 | AZ |
N | 208600000X | Surgeon | 49308 | AZ |
Y | 208200000X | Surgeon | A110607 | CA |
Y | 208600000X | Surgeon | A110607 | CA |
N | 2082S0105X | Plastic Hand Surgeon | 49308 | AZ |
N | 2086S0122X | Plastic and Reconstructive Surgery | 49308 | AZ |
NPI | 1861653255 |
---|---|
Provider Name | John Ray Talley |
First Address | Tucson, AZ 85750-6161 |
Second Address | Tucson, AZ 85715-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 19/04/2021 |