Individual
MR. BRETT ALEXANDER TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-S
Contact information
Practice address
1819 CAREW ST, FORT WAYNE, IN 46805-4705
(260) 702-8055
Mailing address
1635 BAYVIEW DR, FORT WAYNE, IN 46815-4203
(616) 848-5953
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
11/27/2023
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