Individual
DR. EPHRAIM ISAAC THALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 LONDONDERRY DR, SUITE 100, WACO, TX 76712-7900
(254) 751-1144
(254) 751-1185
Mailing address
333 LONDONDERRY DR, SUITE 100, WACO, TX 76712-7900
(254) 751-1144
(254) 751-1185
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
L4144
TX
207KA0200X
Allergy Physician
L4144
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00712N
MEDICARE GROUP PTAN
TX
01
—
151825100
FIRST CARE
—
05
—
180355301
—
TX
01
—
8V9670
BCBS
—
01
—
P00428353
RAILROAD MEDICARE
—
Enumeration date
05/23/2006
Last updated
12/27/2021
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