Maylack, Fallon H
Maylack, Fallon H is an individual health care provider with primary practice located at 12255 De Paul Dr Ste 845, Bridgeton MO 63044-2510. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Maylack, Fallon H can be contacted via phone (314) 884-6320.Contact Information
Primary practice address
12255 De Paul Dr Ste 845
Bridgeton MO 63044-2510
Phone: (314) 884-6320
Fax: (314) 884-6321
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | R5E50 | Missouri |
Profile Details
| NPI number | 1184642993 |
|---|---|
| LBN Legal business name | Maylack, Fallon H |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 18th, 2006 |
| Last updated | Feb 13th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184642993 | NPPES |
| Missouri | MEDICAID | 207746702 |
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