Provider Demographics
NPI:1871500116
Name:TALLEY, BRENDA J (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7703 FLOYD CURL DR FL 7
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-6440
Mailing Address - Fax:210-450-2104
Practice Address - Street 1:7703 FLOYD CURL DR FL 7
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-450-6440
Practice Address - Fax:210-450-2104
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG83952084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040922902OtherCIDC
TX040922901Medicaid
TX8L11328Medicare PIN
TX040922902OtherCIDC