Provider Demographics
NPI:1457315632
Name:NIELSEN, ANTON PETER (MD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:PETER
Last Name:NIELSEN
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 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:713-441-9909
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:713-441-9909
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01309426OtherRR MEDICARE
TXG1493OtherPHYSICIAN LICENSE
TX114877706Medicaid
TXP01098536OtherRR MEDICARE
TX1457315632OtherBLUE CROSS BLUE SHIELD
TX8EE733OtherBLUE CROSS BLUE SHIELD
TX114877705Medicaid
TX114877704Medicaid
TX114877705Medicaid
TXP01098536OtherRR MEDICARE
TX8EE733OtherBLUE CROSS BLUE SHIELD
TXTXB162704Medicare PIN