MEDICARE: REILLY TALBOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	PA15917	TX
2	363A00000X	Physician Assistant	PA15917	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689309981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REILLY TALBOT

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 FM 1464 RD STE A
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-9542
Country	:	US
Telephone Number	:	281-766-3811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	03/30/2023

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Directions to “ REILLY TALBOT ” Practice Location

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