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NPI Code Detail

MEDICARE: J WILLIAM NEILSON MD

MEDICARE:   J WILLIAM NEILSON  MD
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
1208600000XSurgery PhysicianF6992TX

General Provider Information

NPI Number : 1720061724
Entity Type Code : Individual
Provider Name (Legal Business Name) : J WILLIAM NEILSON MD
Provider Business Mailing Address
First Line : PO BOX 2533
Second Line :
City : AMARILLO
State : TX
Zip : 79105-2533
Country : US
Telephone Number : 806-212-6640
Fax Number : 806-212-6278
Provider Business Practice Location Address
First Line : 6 MEDICAL DR
Second Line :
City : AMARILLO
State : TX
Zip : 79106-4136
Country : US
Telephone Number : 806-353-6604
Fax Number : 806-359-0938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 07/08/2007

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