Individual
FALLON LANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 5TH ST S STE 302, SAINT PETERSBURG, FL 33701-4804
(813) 505-2377
(813) 200-3491
Mailing address
601 5TH ST S STE 302, SAINT PETERSBURG, FL 33701-4804
(727) 767-4176
(727) 767-4379
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9110340
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020882500
—
FL
Enumeration date
05/10/2017
Last updated
09/09/2019
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