Provider Demographics
NPI:1770691412
Name:TALBOT, ADRIAN DEXTER (MD JD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:DEXTER
Last Name:TALBOT
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2206
Mailing Address - Country:US
Mailing Address - Phone:985-726-0500
Mailing Address - Fax:985-726-0544
Practice Address - Street 1:1410 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2206
Practice Address - Country:US
Practice Address - Phone:985-726-0500
Practice Address - Fax:985-726-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26834207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA47556Medicaid
LA4F405Medicare ID - Type Unspecified
88645Medicare UPIN
LA4F405DH04Medicare PIN