Individual
MR. DAVID PEARCE FANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4262
Mailing address
8198 WALNUT HILL LN, SUITE 2007, DALLAS, TX 75231-4316
(214) 345-4733
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA08166
TX
363AM0700X
Medical Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P02592787
MCRR
TX
01
—
P02592821
MCRR
TX
Enumeration date
02/14/2013
Last updated
04/06/2021
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