Provider Demographics
NPI:1316044829
Name:TALIAFERRO, LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:
Last Name:TALIAFERRO
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 1:1904 PINE ST.
Mailing Address - Street 2:STE. 3-G
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2303
Mailing Address - Country:US
Mailing Address - Phone:325-670-5330
Mailing Address - Fax:325-670-5335
Practice Address - Street 1:1904 PINE ST.
Practice Address - Street 2:SUITE 3-G
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2303
Practice Address - Country:US
Practice Address - Phone:325-670-5330
Practice Address - Fax:325-670-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGO184208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089535102Medicaid
B26841Medicare UPIN
TX089535102Medicaid