Doctor Name: | JOSEPH ANDREW NELSON |
NPI Number: | 1184044968 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | BP10049936 |
Business Practice Address: | 1500 S Main St Fhc, 4th Floor Fort Worth, TX - 761044917 |
Business Phone Number: | 8177021215 |
Business Fax Number: | 8177021697 |
Mailing Address: | 1500 S Main St, Fhc, 4th Floor FORT WORTH |
State: | TX |
Postal Code: | 761044917 |
Phone Number: | 8177021215 |
Fax Number: | 8177021697 |
NPI Enumeration Date: | 04/21/2014 |
NPI Last Update Date: | 04/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10049936 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |