Individual
CHRISTOPHER MARK FALLOWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3075 W GULF TO LAKE HWY, LECANTO, FL 34461-9228
(352) 527-0102
(352) 527-8863
Mailing address
70 N LECANTO HWY, LECANTO, FL 34461-9190
(352) 527-4444
(352) 746-7829
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS5879
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
OS 5879
FL
208VP0014X
Interventional Pain Medicine Physician
OS5879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063914100
—
FL
01
—
211834
AVMED VENDOR ID
FL
01
—
80355
BCBS PROV ID
FL
01
—
80355X
MEDICARE - NATURECOAST PAIN ASSOCIATES
FL
Enumeration date
07/05/2006
Last updated
05/21/2024
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