Individual
DR. MARK SHANE TALBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1223 GATEWAY DR, SUITE 2B, MELBOURNE, FL 32901-2607
(321) 725-4500
(321) 727-0975
Mailing address
3466 N HARBOR CITY BLVD, MELBOURNE, FL 32935-5713
(321) 434-1982
(321) 727-0975
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD0000035863
TN
208600000X
Surgery Physician
Primary
ME101090
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000086800
—
FL
01
—
32763
BCBS OF FLORIDA
FL
01
—
4314703
CIGNA PIN
FL
Enumeration date
07/06/2006
Last updated
09/08/2016
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