MEDICARE: THOMAS D NELSON D.O.

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	E1689	TX

General Provider Information

NPI Number	:	1588811491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS D NELSON D.O.

Provider Business Mailing Address
First Line	:	507 WASHINGTON DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2253
Country	:	US
Telephone Number	:	817-521-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 WASHINGTON DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2253
Country	:	US
Telephone Number	:	817-521-4559
Fax Number	:

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	01/28/2010

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