Provider Demographics
NPI:1598700338
Name:TALBERT, CLIFFORD R JR (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:R
Last Name:TALBERT
Suffix:JR
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 15
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-3333
Practice Address - Fax:573-331-3334
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO27291207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100170640Medicaid
MOP00964448OtherRR MEDICARE
IL1598700338Medicaid
MO201669827Medicaid
AR188125001Medicaid
MOP00964448OtherRR MEDICARE
MO201669827Medicaid