Individual
MR. MARK R TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP, BOCPO
Contact information
Practice address
3224 LAKE WOODARD DR STE 100, RALEIGH, NC 27604-3659
(919) 231-6890
(919) 231-3490
Mailing address
3224 LAKE WOODARD DR STE 100, RALEIGH, NC 27604-3659
(919) 231-6890
(919) 231-3490
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP003252
DE
Other
Enumeration date
03/08/2020
Last updated
03/08/2020
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