Individual
DR. JONATHON LEE FALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1513 UNION AVE, SUITE 1400, MOBERLY, MO 65270
(660) 263-6677
(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
2002006341
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061748265652701
—
IL
01
—
154392
BLUE CROSS/BLUE SHEILD
MO
05
—
305751208
—
MO
01
—
5502300001
DMERC
MO
01
—
P00241817
RAILROAD MEDICARE
MO
01
—
P00242773
RAILROAD MEDICARE
IL
01
—
P00242773
RAILROAD MEDICARE
MO
Enumeration date
07/20/2006
Last updated
10/19/2015
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