Individual
FALLON SMITH HAYES BANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 22ND AVE S, ST PETERSBURG, FL 33705-2933
(727) 310-0925
Mailing address
901 22ND AVE S, ST PETERSBURG, FL 33705-2933
(727) 310-0925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME165869
FL
Other
Enumeration date
04/15/2018
Last updated
12/12/2023
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