Provider Demographics
NPI:1689963456
Name:TALLEYRAND, JEAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:L
Last Name:TALLEYRAND
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 174
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95494-0174
Mailing Address - Country:US
Mailing Address - Phone:415-722-5195
Mailing Address - Fax:415-704-3324
Practice Address - Street 1:1426 FILLMORE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-5236
Practice Address - Country:US
Practice Address - Phone:415-722-5195
Practice Address - Fax:415-704-3324
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61572208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice