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General NPI Number Information
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NPI Number | 1104829134
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Entity Type | Individual
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Provider Name | RANDALL FALCONER MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1728 N EASTMAN RD
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City | KINGSPORT
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State | TN
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Zip | 37664-2371
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Country | US
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Telephone | 423-230-6532
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Fax | 423-230-4859
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Provider Business Mailing Address
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Address Line | 1728 N EASTMAN RD
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City | KINGSPORT
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State | TN
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Zip | 37664-2371
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Country | US
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Telephone | 423-230-6532
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Fax | 423-230-4859
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD 18839
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License Number State | TN
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