Individual
PHILIP W TALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 3RD AVE W, SUITE 200, BRADENTON, FL 34205-8626
(941) 794-3118
(941) 782-2017
Mailing address
200 3RD AVE W, SUITE 200, BRADENTON, FL 34205-8626
(941) 794-3118
(941) 782-2017
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME53442
FL
2085R0202X
Diagnostic Radiology Physician
ME53442
FL
2086S0129X
Vascular Surgery Physician
ME53442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264536000
—
FL
05
—
264537800
—
FL
Enumeration date
04/25/2006
Last updated
04/23/2010
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