Provider Demographics
NPI:1861440455
Name:FALSARELLA, JOHN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEITH
Last Name:FALSARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2901 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2928
Mailing Address - Country:US
Mailing Address - Phone:580-332-8900
Mailing Address - Fax:580-332-9052
Practice Address - Street 1:2901 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2928
Practice Address - Country:US
Practice Address - Phone:580-332-8900
Practice Address - Fax:580-332-9052
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC94912Medicare UPIN