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Organization
JONATHON FALLIS DPM LLC
Active
Organization
JONATHON FALLIS DPM LLC
Active
Other names
Moberly Foot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHON LEE FALLIS DPM (OWNER)
(660) 263-6677
Entity
Organization
Contact information
Practice address
1513 UNION AVE, SUITE 1400, MOBERLY, MO 65270
(660) 263-6688
(660) 263-6688
Mailing address
1513 UNION AVE, SUITE 1400, MOBERLY, MO 65270
(660) 263-6677
(660) 263-6688
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004851
IL
213E00000X
Podiatrist
2002006341
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154392
BCBS
MO
01
—
5502300001
MEDICARE DMERC
MO
01
—
P0038451
RAILROAD MEDICARE
MO
Enumeration date
07/20/2006
Last updated
04/20/2008
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