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1513 Union Ave, Suite 1400, Moberly, MO 65270 | |
(660) 263-6688 | |
(660) 263-6688 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist |
Location | 1513 Union Ave, Moberly, Missouri |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1154341592 | NPI | - | NPPES |
P0038451 | Other | MO | RAILROAD MEDICARE |
154392 | Other | MO | BCBS |
5502300001 | Other | MO | MEDICARE DMERC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 016004851 (Illinois) | Primary |
213E00000X | Podiatrist | 2002006341 (Missouri) | Secondary |
Provider Name | Jonathon L Fallis |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1659391084 PECOS PAC ID: 1355398884 Enrollment ID: I20050708000463 |
Mailing Address | Practice Location Address |
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1513 Union Ave, Suite 1400, Moberly, MO 65270 Ph: (660) 263-6677 | 1513 Union Ave, Suite 1400, Moberly, MO 65270 Ph: (660) 263-6688 |
Dr. Jonathon Lee Fallis, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1513 Union Ave, Suite 1400, Moberly, MO 65270 Phone: 660-263-6677 Fax: 660-263-6688 |