Individual
KYLE S FALLGATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2639 OAK ST, JACKSONVILLE, FL 32204-4505
(904) 387-5600
(904) 388-0114
Mailing address
2639 OAK ST, JACKSONVILLE, FL 32204-4505
(904) 387-5600
(904) 996-1446
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
101374
GA
207W00000X
Ophthalmology Physician
Primary
ME168086
FL
207WX0107X
Retina Specialist (Ophthalmology) Physician
101374
GA
207WX0107X
Retina Specialist (Ophthalmology) Physician
ME168086
FL
Other
Enumeration date
04/03/2018
Last updated
08/21/2024
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