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NPI Code Detail

MEDICARE: JOHN H FALLON M.D.

MEDICARE: JOHN H FALLON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician01035289AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2040014980OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326040395
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN H FALLON M.D.
Provider Business Mailing Address
First Line : 10021 DUPONT CIRCLE CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1604
Country : US
Telephone Number : 260-426-8117
Fax Number : 260-420-0817
Provider Business Practice Location Address
First Line : 10021 DUPONT CIRCLE CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1604
Country : US
Telephone Number : 260-426-8117
Fax Number : 260-420-0817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/06/2013

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