Provider Demographics
NPI:1629078746
Name:TALTON, DAVID SMITH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SMITH
Last Name:TALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7062
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-7062
Mailing Address - Country:US
Mailing Address - Phone:662-377-7170
Mailing Address - Fax:662-377-2423
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:NMMC EAST TOWER 4TH FLOOR
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-7170
Practice Address - Fax:662-377-2423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12809208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118029Medicaid
AL730-01062OtherBCBS
MS00118029Medicaid