Provider Demographics
NPI:1801808316
Name:FALLON, MICHEAL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:J
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:SHRINERS HOSPITALS FOR CHILDREN SPOKANE
Mailing Address - Street 2:DEPT 5046
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5046
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:911 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2901
Practice Address - Country:US
Practice Address - Phone:509-623-0428
Practice Address - Fax:509-623-0415
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042809207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77499Medicare UPIN