Provider Demographics
NPI:1144215856
Name:TALLEY, TERRY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
Last Name:TALLEY
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 1:201 W IOWA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1721
Mailing Address - Country:US
Mailing Address - Phone:812-424-2020
Mailing Address - Fax:812-424-3000
Practice Address - Street 1:201 W IOWA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1721
Practice Address - Country:US
Practice Address - Phone:812-424-2020
Practice Address - Fax:812-424-3000
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020881207W00000X
IL036085856207W00000X
KY33096207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4005761OtherAETNA
000000042322OtherANTHEM
IN100242690Medicaid
KY64347057Medicaid
116701OtherHEALTHLINK
E03914Medicare UPIN
182068829Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ILL59643Medicare ID - Type Unspecified
4005761OtherAETNA