Organization
JOHN ANTON FACKENTHALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANTON FACKENTHALL DO (PHYSICIAN/OWNER)
(509) 525-4100
Entity
Organization
Contact information
Practice address
1312 E ISAACS AVE, WALLA WALLA, WA 99362-2152
(509) 525-4100
(509) 529-7033
Mailing address
1312 E ISAACS AVE, WALLA WALLA, WA 99362-2152
(509) 525-4100
(509) 529-7033
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00000703
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1252808
—
WA
Enumeration date
11/14/2007
Last updated
01/03/2013
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