Provider Demographics
NPI:1164571360
Name:NATHANSON, JON E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14691 KELMSCOT DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7291
Mailing Address - Country:US
Mailing Address - Phone:214-691-0760
Mailing Address - Fax:214-691-5434
Practice Address - Street 1:810 N ZANG BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4233
Practice Address - Country:US
Practice Address - Phone:214-941-4243
Practice Address - Fax:214-941-1153
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6747OtherMEDICARE INDIVIDUAL PTAN