Individual
BRADLEY EDWARD TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1705 CHRISTY DR, STE. 101, JEFFERSON CITY, MO 65101-5195
(573) 635-0115
(573) 635-0116
Mailing address
1705 CHRISTY DR, STE. 101, JEFFERSON CITY, MO 65101-5195
(573) 635-0115
(573) 635-0116
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2013006634
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548471618
MEDICARE NPI
MO
05
—
1548471618
—
MO
Enumeration date
05/24/2007
Last updated
06/24/2015
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