Provider Demographics
NPI:1093745705
Name:FALLOWS, CHRISTOPHER MARK (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:FALLOWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9190
Mailing Address - Country:US
Mailing Address - Phone:352-527-4444
Mailing Address - Fax:352-746-7829
Practice Address - Street 1:70 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9190
Practice Address - Country:US
Practice Address - Phone:352-527-4444
Practice Address - Fax:352-746-7829
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5879207LP2900X
FLOS5879208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063914100Medicaid
FL211834OtherAVMED VENDOR ID
FL80355OtherBCBS PROV ID
FL80355XOtherMEDICARE - NATURECOAST PAIN ASSOCIATES
FL80355ZMedicare ID - Type UnspecifiedMEDICARE PROV ID
FL211834OtherAVMED VENDOR ID