Provider Demographics
NPI:1841243110
Name:BERRIOS, NELSON A (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1812
Mailing Address - Country:US
Mailing Address - Phone:713-981-9971
Mailing Address - Fax:713-981-1457
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-981-9971
Practice Address - Fax:713-981-1457
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH10412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014682OtherAMERIGROUP
TX375890300OtherDEPT OF LABOR
TX4010178OtherAETNA
TX119003502Medicaid
TX871312OtherBLUE CROSS BLUE SHIELD
BE0871312OtherBCBS OUT OF STATE
TX29053OtherTEXAN PLUS
TX130010767OtherRAILROAD MEDICARE
MDH1041OtherW/C
MDH1041OtherW/C
TX119003502Medicaid