Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 41473 | TX |
NPI | 1033120100 |
---|---|
Provider Name | Dr. Thomas Nelius |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79415-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162095 | (02) | TX |
45456283 | (05) | NM |
8G7987 | BC/BS (01) | TX |
8G8023 | TX MEDICARE (01) | TX |