Provider Demographics
NPI:1659483949
Name:TALBERT, LOUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:G
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 1:7550 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1780
Mailing Address - Country:US
Mailing Address - Phone:901-767-5000
Mailing Address - Fax:901-767-6000
Practice Address - Street 1:7550 WOLF RIVER BLVD
Practice Address - Street 2:# 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1780
Practice Address - Country:US
Practice Address - Phone:901-767-5000
Practice Address - Fax:901-767-6000
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016704207R00000X
MS12425207R00000X
VA45058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01108755Medicaid
3029844Medicare ID - Type Unspecified
TN01108755Medicaid
110230463Medicare ID - Type UnspecifiedRAILROAD MEDICARE