MEDICARE: DR. PAUL WAYNE NELSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	11841	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8L27514	OTHER	TX	MEDICARE GROUP

General Provider Information

NPI Number	:	1689769135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WAYNE NELSON DDS

Provider Business Mailing Address
First Line	:	1200 E BRIN ST
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-2938
Country	:	US
Telephone Number	:	972-551-8005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E BRIN ST
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-2938
Country	:	US
Telephone Number	:	972-551-8005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/14/2010

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