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General NPI Number Information
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NPI Number | 1922676329
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Entity Type | Organization
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Legal Business Name | M3 NELSON LLC
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 701 E BLUFF ST APT 7209
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City | FORT WORTH
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State | TX
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Zip | 76102-2375
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Country | US
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Telephone | 702-767-9192
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Fax | 361-452-8359
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Provider Business Mailing Address
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Address Line | 701 E BLUFF ST APT 7209
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City | FORT WORTH
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State | TX
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Zip | 76102-2375
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Country | US
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Telephone | 702-767-9192
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Fax | 361-452-8359
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHALE MIRZOYAN
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Credential | MD
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Telephone | 702-767-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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