Provider Demographics
NPI:1093824153
Name:TALATALA, RUFINO GERONA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUFINO
Middle Name:GERONA
Last Name:TALATALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 MEDICAL PKWY
Mailing Address - Street 2:BLDG 200, SUITE 250
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-492-0333
Mailing Address - Fax:972-394-6585
Practice Address - Street 1:4221 MEDICAL PKWY
Practice Address - Street 2:BLDG 200, SUITE 250
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-492-0333
Practice Address - Fax:972-394-6585
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030188901Medicaid
G88541Medicare UPIN
TX8947NOMedicare ID - Type Unspecified