MEDICARE: DR. AMY LEE TALBERT 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	207Q00000X	Family Medicine Physician	GRADUATE STUDENT	TX
2	207Q00000X	Family Medicine Physician	M4577	TX

General Provider Information

NPI Number	:	1659399798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LEE TALBERT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 848476
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8476
Country	:	US
Telephone Number	:	254-202-4655
Fax Number	:	254-202-4716

Provider Business Practice Location Address
First Line	:	9821 CHINA SPRING RD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-4800
Country	:	US
Telephone Number	:	254-202-7400
Fax Number	:	254-202-7450

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/18/2021

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