Provider Demographics
NPI:1518051341
Name:NELSON, LAN ALBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:ALBIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L
Other - Middle Name:A
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:70E LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POINTBLANK
Mailing Address - State:TX
Mailing Address - Zip Code:77364-6982
Mailing Address - Country:US
Mailing Address - Phone:936-377-5451
Mailing Address - Fax:
Practice Address - Street 1:1221 UNIVERSITY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4632
Practice Address - Country:US
Practice Address - Phone:936-291-6274
Practice Address - Fax:936-291-6274
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG04962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096513901Medicaid
TX096513901Medicaid
C19828Medicare UPIN