Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G6881 | TX |
NPI | 1033175799 |
---|---|
Provider Name | Richard D. Tallman |
First Address | Austin, TX 78758-2401 |
Second Address | Austin, TX 78758-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128665002 | (05) | TX |