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NPI Code Detail

MEDICARE: RANDOLPH ALVIN NELSON M.D.

MEDICARE: RANDOLPH ALVIN 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
1207P00000XEmergency Medicine PhysicianL1949TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5930117290OTHERTXRAILROAD MEDICARE PROV #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18G1501OTHERTXBC/BS PROVIDER NUMBER
21508846742OTHERTXBCBSTX
31508846742OTHERTXTRICARE SOUTH
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508846742
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH ALVIN NELSON M.D.
Provider Business Mailing Address
First Line : 2606 IRIS CT
Second Line :
City : PEARLAND
State : TX
Zip : 77584-9400
Country : US
Telephone Number : 281-412-9026
Fax Number : 281-412-4195
Provider Business Practice Location Address
First Line : 1401 ST JOSEPH PKWY
Second Line :
City : HOUSTON
State : TX
Zip : 77002-8301
Country : US
Telephone Number : 713-757-7557
Fax Number : 713-756-5922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2006
Last Update Date : 09/21/2010

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Directions to “ RANDOLPH ALVIN NELSON M.D.” Practice Location

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