Provider Demographics
NPI:1093927709
Name:NELSON, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301039
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1039
Mailing Address - Country:US
Mailing Address - Phone:281-784-1500
Mailing Address - Fax:281-209-8930
Practice Address - Street 1:720 N DENTON TAP RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2162
Practice Address - Country:US
Practice Address - Phone:469-312-3080
Practice Address - Fax:281-209-8930
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3902000X207PH0002X
TXP9412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093739906OtherTRICARE - SOUTH
TX339445403Medicaid
TX8EG584OtherBCBS
TX1093739906OtherTRICARE - SOUTH