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NPI Code Detail

MEDICARE: RAUL TALLO M.D.

MEDICARE: RAUL TALLO 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
1207RR0500XRheumatology PhysicianME63965FL

General Provider Information

NPI Number : 1982600417
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAUL TALLO M.D.
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line : ATTN: MANAGED CARE DEPT.
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 130 PABLO ST
Second Line :
City : LAKELAND
State : FL
Zip : 33803-3818
Country : US
Telephone Number : 863-284-5941
Fax Number : 863-284-5199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/21/2022

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Directions to “ RAUL TALLO M.D.” Practice Location

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