Provider Demographics
NPI:1609820968
Name:FALLA, JUAN FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FRANCISCO
Last Name:FALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PINE AVE N
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4629
Mailing Address - Country:US
Mailing Address - Phone:813-814-9504
Mailing Address - Fax:813-635-7946
Practice Address - Street 1:120 PINE AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4629
Practice Address - Country:US
Practice Address - Phone:813-814-9504
Practice Address - Fax:813-635-7946
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080089278OtherRAILROAD MEDICARE NUMBER
FL262313700Medicaid
D61507Medicare UPIN
FL07398XMedicare PIN