Individual
DR. MICHAEL A. FALLUCCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14540 OLD SAINT AUGUSTINE RD, SUITE 2391, JACKSONVILLE, FL 32258-7418
(904) 262-3372
(904) 262-3306
Mailing address
11945 SAN JOSE BLVD, BLDG. 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 399-1717
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
ME109463
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14C77
BCBS
FL
Enumeration date
06/08/2007
Last updated
04/11/2012
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