Healthcare Provider Details

I. General information

NPI: 1558381723
Provider Name (Legal Business Name): EMERARDO FALCON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100B MEDICAL DR
LAKE JACKSON TX
77566-5674
US

IV. Provider business mailing address

100B MEDICAL DR
LAKE JACKSON TX
77566-5674
US

V. Phone/Fax

Practice location:
  • Phone: 979-297-6401
  • Fax: 979-297-6809
Mailing address:
  • Phone: 979-297-6401
  • Fax: 979-297-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG3343
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: