Provider Demographics
NPI:1639108848
Name:TALLETT, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:TALLETT
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 1:268 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2200
Mailing Address - Country:US
Mailing Address - Phone:716-672-4040
Mailing Address - Fax:716-672-4057
Practice Address - Street 1:268 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2200
Practice Address - Country:US
Practice Address - Phone:716-672-4040
Practice Address - Fax:716-672-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201018174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist