Healthcare Provider Details

I. General information

NPI: 1447258124
Provider Name (Legal Business Name): JOHN PEYTON TALIAFERRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 EAGLE DR
LOVELAND CO
80537-8059
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 970-619-6450
  • Fax: 970-619-6459
Mailing address:
  • Phone: 970-619-6450
  • Fax: 970-619-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35570
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101242948
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: