Provider Demographics
NPI:1881680353
Name:NELLSCH, VERNER (MD)
Entity Type:Individual
Prefix:
First Name:VERNER
Middle Name:
Last Name:NELLSCH
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 1765
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0033
Mailing Address - Country:US
Mailing Address - Phone:936-327-8844
Mailing Address - Fax:936-327-8129
Practice Address - Street 1:400 BYPASS LN; STE 108
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-5703
Practice Address - Country:US
Practice Address - Phone:936-327-8844
Practice Address - Fax:936-327-8129
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7070174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096317501Medicaid
TX096317501Medicaid
TXC97999Medicare UPIN