Provider Demographics
NPI:1508846742
Name:NELSON, RANDOLPH ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:ALVIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 IRIS CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9400
Mailing Address - Country:US
Mailing Address - Phone:281-412-9026
Mailing Address - Fax:281-412-4195
Practice Address - Street 1:1401 ST JOSEPH PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8301
Practice Address - Country:US
Practice Address - Phone:713-757-7557
Practice Address - Fax:713-756-5922
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1949207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1501OtherBC/BS PROVIDER NUMBER
TX1508846742OtherBCBSTX
TX1508846742OtherTRICARE SOUTH
TX1462699-02Medicaid
TX930117290OtherRAILROAD MEDICARE PROV #
TX1462699-02Medicaid
TX1508846742OtherTRICARE SOUTH