Provider Demographics
NPI:1164043063
Name:TALLEY, DANIEL THOMAS (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:TALLEY
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 1:323 DEVANE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5202
Mailing Address - Country:US
Mailing Address - Phone:229-869-7635
Mailing Address - Fax:
Practice Address - Street 1:2301 ROBESON ST STE 203
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5641
Practice Address - Country:US
Practice Address - Phone:910-615-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-03399208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology