Healthcare Provider Details

I. General information

NPI: 1558360545
Provider Name (Legal Business Name): DORRENCE CONEY TALBUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: D. C. TALBUT MD

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 MONCLOVA RD #2
MAUMEE OH
43537-1863
US

IV. Provider business mailing address

5757 MONCLOVA RD #2
MAUMEE OH
43537-1863
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-7607
  • Fax: 419-893-7608
Mailing address:
  • Phone: 419-893-7607
  • Fax: 419-893-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3502 0459T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: