Provider Demographics
NPI:1396752259
Name:NELSON, DAVID GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9055 KATY FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1629
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:713-461-5307
Practice Address - Street 1:9511 HUFFMEISTER ROAD
Practice Address - Street 2:100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2865
Practice Address - Country:US
Practice Address - Phone:713-461-2915
Practice Address - Fax:713-461-5307
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6465173000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDH6465OtherWORKER'S COMP
TX134538106Medicaid
TX86K856Medicare PIN
TXE33691Medicare UPIN