Provider Demographics
NPI:1487633384
Name:NILSSON, JOEL B (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:B
Last Name:NILSSON
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 1:411 OGRADY ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2506
Mailing Address - Country:US
Mailing Address - Phone:210-288-4423
Mailing Address - Fax:210-481-1705
Practice Address - Street 1:110 E BANDERA RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2802
Practice Address - Country:US
Practice Address - Phone:210-481-1700
Practice Address - Fax:210-481-1705
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1985207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352506501Medicaid
TX352506501Medicaid