Provider Demographics
NPI:1659352094
Name:TALBERT, KENNETH EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EARL
Last Name:TALBERT
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 1:1128 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5776
Mailing Address - Country:US
Mailing Address - Phone:515-239-4460
Mailing Address - Fax:515-239-4437
Practice Address - Street 1:1128 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5776
Practice Address - Country:US
Practice Address - Phone:515-239-4460
Practice Address - Fax:515-239-4437
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27624207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0063529Medicaid
IA29714Medicare ID - Type Unspecified
IAE43219Medicare UPIN