Provider Demographics
NPI:1730128117
Name:TALLEY, ROCKEY (MD)
Entity Type:Individual
Prefix:
First Name:ROCKEY
Middle Name:
Last Name:TALLEY
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 1:1001 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5251
Mailing Address - Country:US
Mailing Address - Phone:405-582-7972
Mailing Address - Fax:405-733-7167
Practice Address - Street 1:9020 E RENO AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3336
Practice Address - Country:US
Practice Address - Phone:405-732-7119
Practice Address - Fax:405-732-7120
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3859146Medicaid
TNP00282986OtherRAILROAD MEDICARE
TN4045048OtherBCBS OF TN
KY64128846Medicaid
TND35336Medicare UPIN
TN3859146Medicaid