Provider Demographics
NPI:1154332138
Name:NELESON, CRAIG SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:SCOTT
Last Name:NELESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1905
Mailing Address - Country:US
Mailing Address - Phone:214-618-6852
Mailing Address - Fax:214-618-2102
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1905
Practice Address - Country:US
Practice Address - Phone:214-618-6852
Practice Address - Fax:214-618-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1970174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T12UMedicare ID - Type Unspecified
TXI24751Medicare UPIN