MEDICARE: DR. RANDALL FALCONER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD 18839	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104829134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL FALCONER MD

Provider Business Mailing Address
First Line	:	1728 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2371
Country	:	US
Telephone Number	:	423-230-6532
Fax Number	:	423-230-4859

Provider Business Practice Location Address
First Line	:	1728 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2371
Country	:	US
Telephone Number	:	423-230-6532
Fax Number	:	423-230-4859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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