Healthcare Provider Details

I. General information

NPI: 1003866245
Provider Name (Legal Business Name): BEVERLY JEAN TALBERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST OUPB5350
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

1122 NE 13TH ST ORI 274
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4864
  • Fax: 405-271-1643
Mailing address:
  • Phone: 405-271-4864
  • Fax: 405-271-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15844
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: