Individual
DR. DONALD TALLACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 CITYWEST BLVD STE 300, HOUSTON, TX 77042-2549
(713) 620-4000
Mailing address
P O B 840853 STE 200, DALLAS, TX 75284-4817
(972) 233-1999
(972) 233-3666
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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