Healthcare Provider Details

I. General information

NPI: 1134167695
Provider Name (Legal Business Name): ROBERT TALAC M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/21/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 SOUTHWEST FWY STE 1220
HOUSTON TX
77027-7338
US

IV. Provider business mailing address

4126 SOUTHWEST FWY STE 1220
HOUSTON TX
77027-7338
US

V. Phone/Fax

Practice location:
  • Phone: 346-278-5330
  • Fax: 833-857-0028
Mailing address:
  • Phone: 346-278-5330
  • Fax: 833-857-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberP8549
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number45232
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: