Individual
DR. ERIC MICHAEL TALLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 LATHROP ST., STE 207, FAIRBANKS, AK 99701
(907) 456-7768
Mailing address
315 ILLINOIS ST, FAIRBANKS, AK 99701-2910
(907) 456-7768
(907) 456-8050
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
3111
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040006075
MEDICARE RR
AK
05
—
MD0112
—
AK
Enumeration date
10/13/2006
Last updated
12/09/2010
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