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General NPI Number Information
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NPI Number | 1336594738
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Entity Type | Individual
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Provider Name | JONATHAN CHARLES DAVID D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 400 E STATE HIGHWAY 243 STE 18
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City | CANTON
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State | TX
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Zip | 75103-2445
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Country | US
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Telephone | 903-287-5011
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Fax | 903-287-5017
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Provider Business Mailing Address
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Address Line | 801 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-5312
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Country | US
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Telephone | 903-887-1011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S0446
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S0446
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License Number State | TX
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