Healthcare Provider Details

I. General information

NPI: 1285610972
Provider Name (Legal Business Name): DAVID HARRIS NATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 PONCE DE LEON BLVD SUITE 7
CLEARWATER FL
33756-1073
US

IV. Provider business mailing address

1016 PONCE DE LEON BLVD SUITE 7
BELLEAIR FL
33756-1069
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-2131
  • Fax: 727-585-8683
Mailing address:
  • Phone: 727-584-2131
  • Fax: 727-585-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0024463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: