Provider Demographics
NPI:1538140090
Name:NELSON, MARK W (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3338 OAKWELL COURT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3019
Mailing Address - Country:US
Mailing Address - Phone:210-656-5000
Mailing Address - Fax:210-656-7892
Practice Address - Street 1:3338 OAKWELL COURT
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3019
Practice Address - Country:US
Practice Address - Phone:210-656-5000
Practice Address - Fax:210-656-7892
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG7857207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114876902Medicaid
TX114876902Medicaid
TX00GD23Medicare PIN