MEDICARE: JENNINGS C FALCON II 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	2084N0400X	Neurology Physician	24828	WA

General Provider Information

NPI Number	:	1710948294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNINGS C FALCON II MD

Provider Business Mailing Address
First Line	:	301 W POPLAR ST
Second Line	:	SUITE 230
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2800
Country	:	US
Telephone Number	:	509-525-1084
Fax Number	:	509-529-7866

Provider Business Practice Location Address
First Line	:	301 W POPLAR ST
Second Line	:	SUITE 230
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2800
Country	:	US
Telephone Number	:	509-525-1084
Fax Number	:	509-529-7866

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

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	07/08/2007

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