Individual
MICHAEL R TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
124 N 6TH ST, OKEENE, OK 73763
(580) 822-4404
(580) 822-4403
Mailing address
124 N 6TH ST, OKEENE, OK 73763
(580) 822-4404
(580) 822-4403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13660
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100123710A
—
OK
01
—
730793801003
BCBS
OK
01
—
P00285340
RAILROAD MEDICARE
—
Enumeration date
06/16/2006
Last updated
11/17/2020
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