MEDICARE: DR. CRYSTAL IRENE TALLMAN D.O.

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	207V00000X	Obstetrics & Gynecology Physician	R5042	TX
2	207V00000X	Obstetrics & Gynecology Physician	OS17129	FL
3	207V00000X	Obstetrics & Gynecology Physician	R5046	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972881654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL IRENE TALLMAN D.O.

Provider Business Mailing Address
First Line	:	3042 N FEDERAL HWY STE 100
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1400
Country	:	US
Telephone Number	:	954-776-4877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3042 N FEDERAL HWY STE 100
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1400
Country	:	US
Telephone Number	:	954-776-4877
Fax Number	:

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	08/04/2021

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Directions to “ DR. CRYSTAL IRENE TALLMAN D.O.” Practice Location

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