Provider Demographics
NPI:1447258124
Name:TALIAFERRO, JOHN PEYTON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PEYTON
Last Name:TALIAFERRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-619-6450
Mailing Address - Fax:970-619-6459
Practice Address - Street 1:1327 EAGLE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-8059
Practice Address - Country:US
Practice Address - Phone:970-619-6450
Practice Address - Fax:970-619-6459
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35570207Q00000X
VA0101242948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01355700Medicaid
VA1447258124Medicaid
VA018105C18Medicare PIN
CO01355700Medicaid
COCOAAA0005Medicare PIN