MEDICARE: JONATHAN NATHAN M.D.

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	208200000X	Plastic Surgery Physician	T0295	TX

General Provider Information

NPI Number	:	1134449374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN NATHAN M.D.

Provider Business Mailing Address
First Line	:	3900 JUNIUS ST STE 605
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1630
Country	:	US
Telephone Number	:	214-814-1711
Fax Number	:	214-292-8709

Provider Business Practice Location Address
First Line	:	3900 JUNIUS ST STE 605
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1630
Country	:	US
Telephone Number	:	214-814-1711
Fax Number	:	214-292-8709

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

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/18/2025

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