Organization
DIEGO FALLON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIEGO FALLON MD (OWNER)
(863) 773-4700
Entity
Organization
Contact information
Practice address
117 W BAY ST, WAUCHULA, FL 33873-3135
(863) 773-4700
(863) 773-2916
Mailing address
117 W BAY ST, WAUCHULA, FL 33873-3135
(863) 773-4700
(863) 773-2916
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
FL
Other
Enumeration date
10/03/2006
Last updated
08/14/2016
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