Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G8817 | TX |
NPI | 1376549626 |
---|---|
Provider Name | Dr. Nelson Anthony Davino |
First Address | Houston, TX 77024-2301 |
Second Address | Richmond, TX 77469-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139804221 | (05) | TX |
139804222 | (05) | TX |
139804223 | (05) | TX |
139804224 | (05) | TX |
139804225 | (05) | TX |
2989737 | AETNA HMO (01) | TX |
34291 | AMERIGROUP (01) | TX |
4654875 | AETNA PPO (01) | TX |
760505966 | TAX ID (01) | TX |
8G9740 | BLUE CROSS BLUE SHIELD (01) | TX |
C15047 | (02) | TX |
G8817 | STATE LICENSE (01) | TX |