Individual
DOUGLAS FALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4001 CARRICK DR STE 160, MEDINA, OH 44256-5392
(330) 723-7005
(330) 723-4854
Mailing address
24701 EUCLID AVE, EUCLID, OH 44117-1714
(330) 723-7005
(330) 723-4854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35073387F
OH
208000000X
Pediatrics Physician
Primary
35-073387
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2315248
—
OH
01
—
942460636083
CARESOURCE
OH
Enumeration date
05/28/2006
Last updated
07/26/2011
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