Provider Demographics
NPI:1700842051
Name:TALLMAN, DAVID HARDY (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HARDY
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 43100
Mailing Address - Street 2:STE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:1712 W ANKLAM RD
Practice Address - Street 2:STE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2660
Practice Address - Country:US
Practice Address - Phone:520-622-7384
Practice Address - Fax:520-622-4899
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-05-02
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Provider Licenses
StateLicense IDTaxonomies
AZ1300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ380866Medicaid
AZZ61791Medicare PIN
AZS83639Medicare UPIN