Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1027 | TX |
NPI | 1164571360 |
---|---|
Provider Name | Dr. Jon E Nathanson |
First Address | Frisco, TX 75035-7291 |
Second Address | Dallas, TX 75208-4233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 20/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8K6747 | MEDICARE INDIVIDUAL PTAN (01) | TX |