| John Anton Fackenthall | |
|
1312 E Isaacs Ave Walla Walla WA 99362-2152 | |
| (509) 525-4100 | |
| (509) 529-7033 |
| Full Name | John Anton Fackenthall |
|---|---|
| Speciality | Family Medicine |
| Location | 1312 E Isaacs Ave, Walla Walla, Washington |
| Authorized Official Name and Position | John Anton Fackenthall (PHYSICIAN/OWNER) |
| Authorized Official Contact | 5095254100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John Anton Fackenthall 1312 E Isaacs Ave Walla Walla WA 99362-2152 Ph: (509) 525-4100 | John Anton Fackenthall 1312 E Isaacs Ave Walla Walla WA 99362-2152 Ph: (509) 525-4100 |
| NPI Number | 1659552057 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 01/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659552057 | NPI | - | NPPES |
| 1252808 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OP00000703 (Washington) | Primary |
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