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General NPI Number Information
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NPI Number | 1093786345
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Entity Type | Individual
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Provider Name | KENNETH WLSON TALCOTT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2301 BEAVER AVE
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City | DES MOINES
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State | IA
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Zip | 50310-3903
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Country | US
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Telephone | 515-255-3181
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Fax | 515-255-9392
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Provider Business Mailing Address
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Address Line | 2301 BEAVER AVE
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City | DES MOINES
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State | IA
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Zip | 50310-3903
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Country | US
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Telephone | 515-255-3181
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Fax | 515-255-9392
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18970
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License Number State | IA
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