Individual
DANIEL FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3515 E FLETCHER AVE, MDC14, TAMPA, FL 33613-4702
(813) 974-8900
(813) 974-3223
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME111119
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004132700
—
FL
01
—
14H53
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/16/2007
Last updated
01/12/2012
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