Healthcare Provider Details

I. General information

NPI: 1114038403
Provider Name (Legal Business Name): MARK DEWITT TALMAGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23505 COUNTY ROAD Y
VONA CO
80861
US

IV. Provider business mailing address

PO BOX 3728
LITTLETON CO
80161-3728
US

V. Phone/Fax

Practice location:
  • Phone: 303-877-7239
  • Fax: 303-761-7316
Mailing address:
  • Phone: 303-877-7239
  • Fax: 866-271-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number27631
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD25119
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0027631
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0027631
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0027631
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: