Provider Demographics
NPI:1629630249
Name:BRIAN NELSON MD PLLC
Entity Type:Organization
Organization Name:BRIAN NELSON MD PLLC
Other - Org Name:FAMILY PRACTICE TX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-317-1537
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-0936
Mailing Address - Country:US
Mailing Address - Phone:682-317-1500
Mailing Address - Fax:
Practice Address - Street 1:1208 W HENDERSON ST STE C
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-8731
Practice Address - Country:US
Practice Address - Phone:682-317-1537
Practice Address - Fax:682-317-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care