Organization
DONALD TALLACKSON MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD TALLACKSON (PRESIDENT)
(713) 464-9621
Entity
Organization
Contact information
Practice address
921 GESSNER RD, HOUSTON, TX 77024-2501
(713) 932-3019
Mailing address
12335 KINGSRIDE LN, STE 339, HOUSTON, TX 77024-4116
(713) 464-9621
(713) 464-3284
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
J5919
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039EN
BLUE CROSS BLUE SHIELD
—
05
—
1305062-05
—
TX
Enumeration date
11/20/2007
Last updated
12/03/2010
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