Provider Demographics
NPI:1265739106
Name:DAVID H NATHAN M.D., P.A.
Entity type:Organization
Organization Name:DAVID H NATHAN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-584-2131
Mailing Address - Street 1:1016 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1073
Mailing Address - Country:US
Mailing Address - Phone:727-584-2131
Mailing Address - Fax:727-585-8683
Practice Address - Street 1:1016 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1073
Practice Address - Country:US
Practice Address - Phone:727-584-2131
Practice Address - Fax:727-585-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024463207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78087Medicare PIN
FLD58363Medicare UPIN