MEDICARE: DIEGO FALLON 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME53500	FL

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	:	1932174794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO FALLON MD

Provider Business Mailing Address
First Line	:	117 W BAY ST
Second Line	:
City	:	WAUCHULA
State	:	FL
Zip	:	33873-3135
Country	:	US
Telephone Number	:	863-773-4700
Fax Number	:	863-773-2916

Provider Business Practice Location Address
First Line	:	5775 PEACHTREE DUNWOODY RD STE 425
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1556
Country	:	US
Telephone Number	:	844-403-4325
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/18/2022

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Directions to “ DIEGO FALLON MD” Practice Location

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