Healthcare Provider Details

I. General information

NPI: 1336594738
Provider Name (Legal Business Name): JONATHAN CHARLES DAVID D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATE HIGHWAY 243 STE 18
CANTON TX
75103-2445
US

IV. Provider business mailing address

801 W MAIN ST
GUN BARREL CITY TX
75156-5312
US

V. Phone/Fax

Practice location:
  • Phone: 903-287-5011
  • Fax: 903-287-5017
Mailing address:
  • Phone: 903-887-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS0446
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS0446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: