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General NPI Number Information
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NPI Number | 1700999703
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Entity Type | Individual
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Provider Name | JOEL DAVID TALLEY III MD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 5000 KY ROUTE 321
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9113
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Country | US
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Telephone | 606-886-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 KY ROUTE 321
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9113
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Country | US
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Telephone | 606-886-7645
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 21377
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License Number State | KY
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