Individual
EVANGELINE TALENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
(817) 250-1815
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
(817) 250-1815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17809
MS
207R00000X
Internal Medicine Physician
Primary
M6417
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186197901
—
TX
Enumeration date
06/21/2006
Last updated
10/20/2015
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