Provider Demographics
NPI:1619932761
Name:TALBOTT, ANDREW P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:TALBOTT
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:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-656-2424
Mailing Address - Fax:435-656-2828
Practice Address - Street 1:1122 CENTER DR STE D350
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5780
Practice Address - Country:US
Practice Address - Phone:435-714-7277
Practice Address - Fax:435-214-2254
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48296207L00000X
UT6353467-1205208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000060991Medicare PIN