Provider Demographics
NPI:1154660975
Name:FANNON, DAVID PEARCE (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PEARCE
Last Name:FANNON
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8198 WALNUT HILL LN
Mailing Address - Street 2:SUITE 2007
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4316
Mailing Address - Country:US
Mailing Address - Phone:214-345-4733
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA08166363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02592821OtherMCRR
TXP02592787OtherMCRR