Provider Demographics
NPI:1700899309
Name:NELSON, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:NELSON
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 5556
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5556
Mailing Address - Country:US
Mailing Address - Phone:432-686-0321
Mailing Address - Fax:432-686-0664
Practice Address - Street 1:5615 DEAUVILLE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706
Practice Address - Country:US
Practice Address - Phone:432-686-0321
Practice Address - Fax:432-686-0664
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3641207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103565104Medicaid
TX103565104Medicaid
D97583Medicare UPIN