Provider Demographics
NPI:1922676329
Name:M3 NELSON LLC
Entity Type:Organization
Organization Name:M3 NELSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-767-9192
Mailing Address - Street 1:701 E BLUFF ST APT 7209
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2375
Mailing Address - Country:US
Mailing Address - Phone:702-767-9192
Mailing Address - Fax:361-452-8359
Practice Address - Street 1:701 E BLUFF ST APT 7209
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2375
Practice Address - Country:US
Practice Address - Phone:702-767-9192
Practice Address - Fax:361-452-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty