Provider Demographics
NPI:1750486304
Name:NELSON, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:NELSON
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-1416
Practice Address - Fax:682-885-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF69942080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138412508Medicaid
TX1640413OtherFIRSTHEALTH PIN
TX120293100OtherFIRSTCARE PIN
TX124173OtherSUPERIOR PIN
TX140442852OtherMEDICAID GROUP TPI
TX4004782OtherAETNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX00U87ZOtherMEDICARE GROUP PIN
TX129719406Medicaid
TX10006616OtherAMERIGROUP PIN
TX129719402Medicaid
TX129719403Medicaid
TX137345810OtherCSHCN GROUP TPI
TX1392962OtherUHC PIN
TX82Y893OtherBCBSTX IND PIN
TX138412506Medicaid
TX129719407OtherCSHCN INDIVIDUAL TPI
1750369203OtherGRP NPI NUMBER
TX5751703OtherCIGNA PIN
TX1392962OtherUHC PIN
TX129719406Medicaid
TX82Y893OtherBCBSTX IND PIN
TX8L22084Medicare PIN