Provider Demographics
NPI:1114038403
Name:TALMAGE, MARK DEWITT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DEWITT
Last Name:TALMAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3728
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80161-3728
Mailing Address - Country:US
Mailing Address - Phone:303-877-7239
Mailing Address - Fax:866-271-0712
Practice Address - Street 1:23505 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:VONA
Practice Address - State:CO
Practice Address - Zip Code:80861
Practice Address - Country:US
Practice Address - Phone:303-877-7239
Practice Address - Fax:303-761-7316
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27631207QA0505X
MEMD25119207QA0505X
CODR.0027631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27631OtherSTATE LICENSE
MEMD25119OtherSTATE LICENSE