Provider Demographics
NPI:1043370588
Name:TALON, MARK D (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:TALON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:TALON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:400 HARBORSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0001
Mailing Address - Country:US
Mailing Address - Phone:409-772-0848
Mailing Address - Fax:409-772-0885
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1022
Practice Address - Country:US
Practice Address - Phone:409-772-0848
Practice Address - Fax:409-772-0885
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX560284367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP06383Medicare UPIN
TX84022HMedicare ID - Type Unspecified