MEDICARE: BRADFORD L TALCOTT 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	2084N0400X	Neurology Physician	47797	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154395101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD L TALCOTT M.D.

Provider Business Mailing Address
First Line	:	2353 CORONADO ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7407
Country	:	US
Telephone Number	:	208-552-4823
Fax Number	:

Provider Business Practice Location Address
First Line	:	2353 CORONADO ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7407
Country	:	US
Telephone Number	:	208-552-4823
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/21/2008

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