| Doctor Name: | IAN O'FALLON |
| NPI Number: | 1891187076 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CNIM |
| License Number: | 2897 |
| Business Practice Address: | 33518 Haley Rd # 1 Waller, TX - 774845110 |
| Business Phone Number: | 8883442947 |
| Business Fax Number: | 2816224381 |
| Mailing Address: | Po Box 1577, WALLER |
| State: | TX |
| Postal Code: | 774841577 |
| Phone Number: | |
| Fax Number: | 2816224381 |
| NPI Enumeration Date: | 02/25/2015 |
| NPI Last Update Date: | 02/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZE0600X |
| License Number: | 2897 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Electroneurodiagnostic |
| Taxonomy Definition: | |