Provider Demographics
NPI:1184600397
Name:NELON, BURLYN CRAIG (DO)
Entity type:Individual
Prefix:DR
First Name:BURLYN
Middle Name:CRAIG
Last Name:NELON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:434 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5330
Mailing Address - Country:US
Mailing Address - Phone:817-447-1208
Mailing Address - Fax:817-447-1106
Practice Address - Street 1:434 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5330
Practice Address - Country:US
Practice Address - Phone:817-447-1208
Practice Address - Fax:817-447-1106
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CW62Medicare PIN
TXD97582Medicare UPIN
TXD97582Medicare UPIN
TX010045673OtherRAILROAD MEDICARE
TXP000CW627Medicaid