Provider Demographics
NPI:1225491004
Name:FALLON, ZACHARY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:PATRICK
Last Name:FALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 EXECUTIVE CENTRE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3394
Practice Address - Country:US
Practice Address - Phone:636-441-3444
Practice Address - Fax:636-441-9832
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41415208100000X
MO2022008983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation