Provider Demographics
NPI:1033143540
Name:NEILSON, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:NEILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 OYSTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3225
Mailing Address - Country:US
Mailing Address - Phone:281-242-6118
Mailing Address - Fax:281-242-6118
Practice Address - Street 1:322 OYSTER CREEK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3225
Practice Address - Country:US
Practice Address - Phone:281-242-6118
Practice Address - Fax:281-242-6118
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7687207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25120Medicare UPIN