Individual
BRYAN V FALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2300 CHAMBERS CENTER DR, SUITE 100, FORT MITCHELL, KY 41017
(859) 331-2440
(859) 331-2449
Mailing address
PO BOX 636389, CINCINNATI, OH 45263-0001
(513) 931-0083
(859) 331-2449
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
00258
KY
213E00000X
Podiatrist
244160
KY
213E00000X
Podiatrist
Primary
36003149
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000619072
ANTHEM
OH
05
—
2214213
—
OH
05
—
2955422
—
OH
05
—
7100096290
—
KY
05
—
80000151
—
KY
01
—
P00732469
RAILROAD MEDICARE
KY
Enumeration date
08/17/2005
Last updated
05/07/2024
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