Healthcare Provider Details

I. General information

NPI: 1669863155
Provider Name (Legal Business Name): THOMAS FALLON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 US HIGHWAY 301 N STE 210
PARRISH FL
34219-8701
US

IV. Provider business mailing address

8927 US HIGHWAY 301 N STE 210
PARRISH FL
34219-8701
US

V. Phone/Fax

Practice location:
  • Phone: 941-845-4652
  • Fax: 941-845-4654
Mailing address:
  • Phone: 941-845-4652
  • Fax: 941-845-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: