MEDICARE: DR. JAMES DANIEL TALLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD17106	TN

General Provider Information

NPI Number	:	1003817115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANIEL TALLEY M.D.

Provider Business Mailing Address
First Line	:	753 SYBILWOOD CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3734
Country	:	US
Telephone Number	:	407-696-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 RAYMOND ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-8208
Country	:	US
Telephone Number	:	407-629-1599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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