Healthcare Provider Details

I. General information

NPI: 1508846742
Provider Name (Legal Business Name): RANDOLPH ALVIN NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ST JOSEPH PKWY
HOUSTON TX
77002-8301
US

IV. Provider business mailing address

2606 IRIS CT
PEARLAND TX
77584-9400
US

V. Phone/Fax

Practice location:
  • Phone: 713-757-7557
  • Fax: 713-756-5922
Mailing address:
  • Phone: 281-412-9026
  • Fax: 281-412-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL1949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: