=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093745705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER MARK FALLOWS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3075 W GULF TO LAKE HWY
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461-9228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-527-0102
-----------------------------------------------------
Fax | 352-527-8863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 N LECANTO HWY
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461-9190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-527-4444
-----------------------------------------------------
Fax | 352-746-7829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | OS 5879
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | OS5879
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | OS5879
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------