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1306843990

NPI Code Detail

MEDICARE: DARRICK P. NELSON M.D

MEDICARE: DARRICK P. NELSON M.D

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	207Q00000X	Family Medicine Physician	L5071	TX
2	207Q00000X	Family Medicine Physician	MD2010-0242	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	NMA100969	OTHER	NM	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AQ389	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306843990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRICK P. NELSON M.D

Provider Business Mailing Address
First Line	:	530 DEMOSS STREET
Second Line	:
City	:	LORDSBURG
State	:	NM
Zip	:	88045-2618
Country	:	US
Telephone Number	:	575-542-8384
Fax Number	:	575-542-8367

Provider Business Practice Location Address
First Line	:	1007 N POPE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5161
Country	:	US
Telephone Number	:	575-388-1511
Fax Number	:	575-388-3465

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/02/2014

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Directions to “ DARRICK P. NELSON M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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