Provider Demographics
NPI:1972545622
Name:FALL, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:FALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:216 3RD ST W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1602
Mailing Address - Country:US
Mailing Address - Phone:715-685-0656
Mailing Address - Fax:715-685-9326
Practice Address - Street 1:216 3RD ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1602
Practice Address - Country:US
Practice Address - Phone:715-685-0656
Practice Address - Fax:715-685-9326
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI34121208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659316396OtherFALL GENERAL SURGERY NPI
WI31934700Medicaid
WI020051837OtherRAILROAD MEDICARE
MN020003026OtherPTAN
WI000104025Medicare PIN
WI020051837OtherRAILROAD MEDICARE