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General NPI Number Information
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NPI Number | 1316097108
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Entity Type | Organization
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Legal Business Name | DANIEL L TALLERICO MD INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3863 S BOULEVARD ST SUITE 100
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City | EDMOND
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State | OK
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Zip | 73013-5519
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Country | US
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Telephone | 405-471-6249
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Fax | 405-471-6255
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Provider Business Mailing Address
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Address Line | 3863 S BOULEVARD SUITE 100
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-471-6249
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Fax | 405-471-6255
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DANIEL TALLERICO
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Credential | MD
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Telephone | 405-471-6249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 10585
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License Number State | OK
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