Individual
DR. DONALD TALLACKSON
Active
Individual
DR. DONALD TALLACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
TX
05
—
1305062-05
—
TX
05
—
130506207
—
TX
01
—
8AG300
BLUE CROSS BLUE SHIELD OF TEXAS
TX
Enumeration date
09/06/2006
Last updated
12/03/2021
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