Provider Demographics
NPI:1184021636
Name:JALLOW, TALATOU
Entity Type:Individual
Prefix:
First Name:TALATOU
Middle Name:
Last Name:JALLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 SILVERADO TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8627
Mailing Address - Country:US
Mailing Address - Phone:214-284-3801
Mailing Address - Fax:
Practice Address - Street 1:2407 SILVERADO TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8627
Practice Address - Country:US
Practice Address - Phone:214-284-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver