Provider Demographics
NPI:1518068303
Name:FALLON, TROY T (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:T
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 1:1046 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1916
Mailing Address - Country:US
Mailing Address - Phone:541-812-4194
Mailing Address - Fax:541-812-4415
Practice Address - Street 1:1046 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1916
Practice Address - Country:US
Practice Address - Phone:541-812-4194
Practice Address - Fax:541-812-4415
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18699207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059297000OtherBCBS
J200012OtherPACIFIC SOURCE
F81049OtherGROUP HEALTH
0215265OtherWASHINGTON L & I
WA8467961Medicaid
OR071709Medicaid
8943179OtherWA CRIME VICTIMS
F81049OtherPROVIDENCE
P00387473OtherRAILROAD MEDICARE
J200012OtherPACIFIC SOURCE
R135808Medicare PIN