Individual
JOHN H FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Mailing address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01035289A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040014980
RR MEDICARE
IN
05
—
0827850
—
OH
05
—
100261520A
—
IN
Enumeration date
08/10/2005
Last updated
02/06/2013
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