MEDICARE: JARED MICHAEL NATHANSON MD

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	390200000X	Student in an Organized Health Care Education/Training Program	227129	NC
2	208M00000X	Hospitalist Physician	S9567	TX

General Provider Information

NPI Number	:	1285168302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED MICHAEL NATHANSON MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-6134
Country	:	US
Telephone Number	:	214-633-5555
Fax Number	:

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

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	07/30/2021

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