Provider Demographics
NPI:1295926574
Name:NELSON, PETER SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SCOTT
Last Name:NELSON
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 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-899-2500
Mailing Address - Fax:409-898-7579
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 430 (BEAUMONT DERMATOLOGY & FAMILY PRACTICE)
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-899-2500
Practice Address - Fax:409-898-7579
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201378207N00000X
TXM9537207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L0820Medicare PIN