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General NPI Number Information
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NPI Number | 1396873725
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Entity Type | Individual
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Provider Name | THOMAS CHARLES LALLY MD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3123 PASADENA CT UNIT 39
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City | DUBUQUE
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State | IA
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Zip | 52001-0846
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Country | US
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Telephone | 563-556-2097
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Fax | 563-556-1570
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Provider Business Mailing Address
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Address Line | 82 FORD DR
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City | EAST DUBUQUE
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State | IL
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Zip | 61025-8510
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Country | US
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Telephone | 815-747-6295
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 20160
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License Number State | IA
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