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General NPI Number Information
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NPI Number | 1407015282
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Entity Type | Organization
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Legal Business Name | BRADFORD L TALCOTT MD PHD PC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 2353 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-552-4823
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Fax | 208-552-4856
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Provider Business Mailing Address
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Address Line | 2353 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-552-4823
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Fax | 208-552-4856
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. BRADFORD L TALCOTT
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Credential | MD PHD
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Telephone | 208-552-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | M10044
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License Number State | ID
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