MEDICARE: MR. JON DAVID SUNDE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00730	TX

General Provider Information

NPI Number	:	1114936200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON DAVID SUNDE PA-C

Provider Business Mailing Address
First Line	:	902 YUKON DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6345
Country	:	US
Telephone Number	:	817-473-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 LONE STAR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6336
Country	:	US
Telephone Number	:	214-689-4420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JON DAVID SUNDE PA-C” Practice Location

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