John Anton Fackenthall

NPI #1659552057 in Walla Walla, Washington

Provider Information

NPI Number: 1659552057
Entity Type: Organization
Organization Name: John Anton Fackenthall
Primary Specialty: Family Medicine
Enumeration Date: Nov 14, 2007
Last Updated: Jan 3, 2013

Practice Location

Address: 1312 E ISAACS AVE
City: Walla Walla
State: Washington
ZIP Code: 99362-2152
Phone: (509) 525-4100

Authorized Official

Name: DR. JOHN ANTON FACKENTHALL, DO
Title: PHYSICIAN/OWNER
Phone: (509) 525-4100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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