Provider Demographics
NPI:1124091384
Name:TALLEY, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:TALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:STE 315
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-698-8290
Mailing Address - Fax:816-698-8291
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:STE 315
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-698-8290
Practice Address - Fax:816-698-8291
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-18959207RH0003X
MO2003003699207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201389517Medicaid
KS100195390BMedicaid
KS100195390BMedicaid
MO565C163EMedicare PIN