Provider Demographics
NPI:1902897051
Name:FALLOON, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:FALLOON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42499207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
140007661OtherRR MEDICARE
996067OtherARAZ GROUP AMERICAS PPO
85D65FAOtherBLUE CROSS BLUE SHIELD
0600040OtherMEDICA HEALTH PLANS
1927405OtherFIRST HEALTH PLAN
127844OtherU CARE
1023510OtherPREFERRED ONE
480677800OtherMEDICAL ASSISTANCE
CI1369OtherRR MEDICARE
HP30505OtherHEALTH PARTNERS
CI1369OtherRR MEDICARE
140007661OtherRR MEDICARE