Healthcare Provider Details

I. General information

NPI: 1164571360
Provider Name (Legal Business Name): JON E NATHANSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N ZANG BLVD
DALLAS TX
75208-4233
US

IV. Provider business mailing address

14691 KELMSCOT DR
FRISCO TX
75035-7291
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-4243
  • Fax: 214-941-1153
Mailing address:
  • Phone: 214-691-0760
  • Fax: 214-691-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: