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NPI Code Detail

MEDICARE: MR. MICHAEL SCOTT NELSON PA-C

MEDICARE:  MR. MICHAEL SCOTT NELSON  PA-C
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
1363A00000XPhysician AssistantPA04398TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11083727986OTHERTXTRICARE SOUTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48Y0711OTHERTXBCBSTX PROVIDER NO

General Provider Information

NPI Number : 1083727986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL SCOTT NELSON PA-C
Provider Business Mailing Address
First Line : 2600 FM 1764 RD
Second Line : STE 190
City : LA MARQUE
State : TX
Zip : 77568-2826
Country : US
Telephone Number : 713-926-6229
Fax Number : 713-926-9292
Provider Business Practice Location Address
First Line : 412 TELEPHONE RD
Second Line :
City : HOUSTON
State : TX
Zip : 77023-1840
Country : US
Telephone Number : 713-926-6229
Fax Number : 713-926-9292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 10/23/2018

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Directions to “ MR. MICHAEL SCOTT NELSON PA-C” Practice Location

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