Provider Demographics
NPI:1114040862
Name:ADKISON, TALISSA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TALISSA
Middle Name:BETH
Last Name:ADKISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1510 E FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5698
Mailing Address - Country:US
Mailing Address - Phone:602-954-0444
Mailing Address - Fax:602-952-7146
Practice Address - Street 1:1510 E FLOWER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5698
Practice Address - Country:US
Practice Address - Phone:602-954-0444
Practice Address - Fax:602-952-7146
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ44957207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine