MEDICARE: ROCKEY TALLEY MD

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	207P00000X	Emergency Medicine Physician	34815	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00282986	OTHER	TN	RAILROAD MEDICARE

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
3	4045048	OTHER	TN	BCBS OF TN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730128117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCKEY TALLEY MD

Provider Business Mailing Address
First Line	:	1001 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5251
Country	:	US
Telephone Number	:	405-582-7972
Fax Number	:	405-733-7167

Provider Business Practice Location Address
First Line	:	9020 E RENO AVE STE 100
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-3336
Country	:	US
Telephone Number	:	405-732-7119
Fax Number	:	405-732-7120

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/09/2018

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Directions to “ ROCKEY TALLEY MD” Practice Location

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