Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 6736 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 774561 | TX |
NPI | 1033105473 |
---|---|
Provider Name | Dr. Gregory W Nelson |
First Address | San Antonio, TX 78232-4108 |
Second Address | San Antonio, TX 78232-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59568 | (02) | TX |