Provider Demographics
NPI:1972881654
Name:TALLMAN, CRYSTAL IRENE (DO)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:IRENE
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:IRENE
Other - Last Name:BEHOFSITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3042 N FEDERAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1400
Mailing Address - Country:US
Mailing Address - Phone:954-776-4877
Mailing Address - Fax:
Practice Address - Street 1:3042 N FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1400
Practice Address - Country:US
Practice Address - Phone:954-776-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5042207V00000X
FLOS17129207V00000X
TXR5046207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS17129Medicaid