Organization
JONATHON FALLIS DPM LLC
Active
Other names
Moberly Foot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHON LEE FALLIS DPM (OWNER)
(660) 263-6677
Entity
Organization
Contact information
Practice address
1513 UNION AVE, SUITE 1400, MOBERLY, MO 65270
(660) 263-6688
(660) 263-6688
Mailing address
1513 UNION AVE, SUITE 1400, MOBERLY, MO 65270
(660) 263-6677
(660) 263-6688
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004851
IL
213E00000X
Podiatrist
2002006341
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154392
BCBS
MO
01
—
5502300001
MEDICARE DMERC
MO
01
—
P0038451
RAILROAD MEDICARE
MO
Enumeration date
07/20/2006
Last updated
04/20/2008
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