Provider Demographics
NPI:1932176898
Name:TALLMAN, GARRETT J (MD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:J
Last Name:TALLMAN
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 1:6125 PASEO DEL NORTE STE 110
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1113
Mailing Address - Country:US
Mailing Address - Phone:760-633-4700
Mailing Address - Fax:760-635-4350
Practice Address - Street 1:6125 PASEO DEL NORTE STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011
Practice Address - Country:US
Practice Address - Phone:760-633-4700
Practice Address - Fax:760-635-4350
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84239207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G842390Medicaid
CAWG84239MOtherPPIN
CAW18361Medicare ID - Type Unspecified
CA00G842390Medicaid