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Individual

JANE E KELLEY TALLMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
100 TAYLOR LN, RONCEVERTE, WV 24970-1337
(304) 647-3434
(304) 647-9789
Mailing address
PO BOX 787, CRAB ORCHARD, WV 25827-0787
(304) 253-5793
(304) 253-0166

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
1770
WV
207Q00000X
Family Medicine Physician
Primary
1770
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001721727
BC
WV
01
1048076
W COMP
WV
05
5600556000
WV
01
P00049529
RR MCARE
WV
Enumeration date
11/02/2005
Last updated
04/24/2009
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