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General NPI Number Information
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NPI Number | 1336512722
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Entity Type | Individual
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Provider Name | MAHINDER PAL SINGH TALWAR RPSGT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 1505 WOODLAWN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3145
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Country | US
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Telephone | 731-676-2894
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 WOODLAWN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3145
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Country | US
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Telephone | 731-676-2894
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Fax |
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 21677
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License Number State | TN
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