Individual
M TERESA TALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2821 E DUPONT RD, FORT WAYNE, IN 46825-1668
(260) 497-0602
(260) 497-0657
Mailing address
2821 E DUPONT RD, FORT WAYNE, IN 46825-1668
(260) 497-0602
(260) 497-0657
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01039505
IN
207V00000X
Obstetrics & Gynecology Physician
01039505
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089022
ANTHEM BCBS
IN
05
—
100104150A
—
IN
Enumeration date
08/19/2005
Last updated
08/23/2011
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