Provider Demographics
NPI:1760485619
Name:TALLMAN, PHILIP GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GLENN
Last Name:TALLMAN
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 1:2294 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7423
Mailing Address - Country:US
Mailing Address - Phone:406-294-9515
Mailing Address - Fax:406-294-9520
Practice Address - Street 1:2294 GRANT RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7423
Practice Address - Country:US
Practice Address - Phone:406-294-9515
Practice Address - Fax:406-294-9520
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-02-15
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
MT8066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0041922Medicaid
WY1118099 00 1180Medicaid
WY309061Medicare PIN
MT0041922Medicaid
G34283Medicare UPIN