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NPI Code Detail

MEDICARE: DR. JOHN WILLIAM LALLY MD

MEDICARE: DR. JOHN WILLIAM LALLY 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
1390200000XStudent in an Organized Health Care Education/Training ProgramTX
2207Y00000XOtolaryngology PhysicianT7272TX
3207Y00000XOtolaryngology Physician2019007499MO

General Provider Information

NPI Number : 1407390339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN WILLIAM LALLY MD
Provider Business Mailing Address
First Line : 18511 HIGHLANDER MEDICS ST
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-5327
Country : US
Telephone Number : 915-742-9351
Fax Number :
Provider Business Practice Location Address
First Line : 18511 HIGHLANDER MEDICS ST
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-5327
Country : US
Telephone Number : 915-742-9351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2016
Last Update Date : 03/10/2026

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