Healthcare Provider Details

I. General information

NPI: 1023432853
Provider Name (Legal Business Name): BRYAN FALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BARNES RD
WILLIAMSTOWN KY
41097-9482
US

IV. Provider business mailing address

238 BARNES RD
WILLIAMSTOWN KY
41097-9482
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-2440
  • Fax:
Mailing address:
  • Phone: 859-331-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRYAN V FALLIS
Title or Position: OWNER
Credential: DPM
Phone: 859-331-2440