Active NPI
Eric Michael Tallan, M.D.
- Otolaryngology Physician
- Fairbanks, AK
National Provider Identifier
1942390919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 3111
- Practice address
- 1919 Lathrop St.
Ste 207
Fairbanks, AK 99701 - Phone
- (907) 456-7768
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 3111 | AK | Primary |
Addresses
Primary practice location
1919 Lathrop St.
Ste 207
Fairbanks, AK 99701
Mailing address
315 Illinois St
Fairbanks, AK 99701-2910
Phone (907) 456-7768
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040006075 | Other | AK | MEDICARE RR |
| MD0112 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291852800000",
"number": "1942390919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 ILLINOIS ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997012910",
"telephone_number": "907-456-7768",
"fax_number": "907-456-8050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 LATHROP ST.",
"address_2": "STE 207",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "99701",
"telephone_number": "907-456-7768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALLAN",
"first_name": "ERIC",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2010-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "AK",
"license": "3111",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "040006075",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD0112",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.