Provider Demographics
NPI:1376549626
Name:DAVINO, NELSON ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ANTHONY
Last Name:DAVINO
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 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:281-344-1715
Mailing Address - Fax:
Practice Address - Street 1:1517 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4932
Practice Address - Country:US
Practice Address - Phone:281-344-1715
Practice Address - Fax:281-344-1716
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8817207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2989737OtherAETNA HMO
TX8G9740OtherBLUE CROSS BLUE SHIELD
TX139804223Medicaid
TX760505966OtherTAX ID
TX139804221Medicaid
TX139804224Medicaid
TX139804222Medicaid
TX139804225Medicaid
TX4654875OtherAETNA PPO
TXG8817OtherSTATE LICENSE
TX34291OtherAMERIGROUP
TX34291OtherAMERIGROUP
TXTXB143893Medicare PIN
TX2989737OtherAETNA HMO
TX139804225Medicaid
TX139804221Medicaid
TX139804222Medicaid