Provider Demographics
NPI:1447228531
Name:FALLER, CARLTON SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:SAMUEL
Last Name:FALLER
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 1207
Mailing Address - Street 2:490 SITMAN AVENUE
Mailing Address - City:GTEENSBURGH
Mailing Address - State:LA
Mailing Address - Zip Code:70441
Mailing Address - Country:US
Mailing Address - Phone:225-222-6059
Mailing Address - Fax:
Practice Address - Street 1:490 SITMAN AVENUE
Practice Address - Street 2:
Practice Address - City:GTEENSBURGH
Practice Address - State:LA
Practice Address - Zip Code:70441
Practice Address - Country:US
Practice Address - Phone:225-222-6059
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.008224208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery