Provider Demographics
NPI:1144278334
Name:TALTON, BROOKS M JR (MD)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:M
Last Name:TALTON
Suffix:JR
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:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1183
Mailing Address - Country:US
Mailing Address - Phone:615-449-9680
Mailing Address - Fax:615-449-9390
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:HVMC/RADIATION ONCOLOGY DEPT
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3810
Practice Address - Country:US
Practice Address - Phone:423-224-5500
Practice Address - Fax:423-224-5439
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000121512085R0001X
VA01010266112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175160Medicaid
VA7287241Medicaid
TN3175160Medicare ID - Type Unspecified
VA7287241Medicaid