Healthcare Provider Details

I. General information

NPI: 1932579489
Provider Name (Legal Business Name): JOEL B NILSSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 02/14/2023
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BANDERA RD
BOERNE TX
78006-2802
US

IV. Provider business mailing address

540 MADISON OAK DR STE 260
SAN ANTONIO TX
78258-3930
US

V. Phone/Fax

Practice location:
  • Phone: 210-481-1700
  • Fax:
Mailing address:
  • Phone: 210-481-1700
  • Fax: 210-481-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL B. NILSSON
Title or Position: PARTNER
Credential: MD
Phone: 210-288-4423