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General NPI Number Information
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NPI Number | 1205255528
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Entity Type | Individual
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Provider Name | JORDAN H TALLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1840 AMHERST ST
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City | WINCHESTER
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State | VA
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Zip | 22601-2808
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Country | US
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Telephone | 540-536-8000
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Fax | 540-536-7780
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Provider Business Mailing Address
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Address Line | PO BOX 603484
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City | CHARLOTTE
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State | NC
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Zip | 28260-3484
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Country | US
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Telephone | 803-765-1838
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Fax | 803-765-1732
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2024031393
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 87911
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0102205112
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License Number State | VA
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