MEDICARE: KETURA TALBOT 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	9893A	WY

General Provider Information

NPI Number	:	1851688352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETURA TALBOT M.D.

Provider Business Mailing Address
First Line	:	3632 AMERICAN WAY
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-234-6765
Fax Number	:	307-234-6998

Provider Business Practice Location Address
First Line	:	3632 AMERICAN WAY
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-234-6765
Fax Number	:	307-234-6998

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	11/21/2016

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