Provider Demographics
NPI:1861573743
Name:NELSON, SCOTT JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JAMES
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 FOREST LN # 515057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2472
Mailing Address - Country:US
Mailing Address - Phone:469-850-5760
Mailing Address - Fax:
Practice Address - Street 1:3930 NAAMAN SCHOOL RD STE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-0968
Practice Address - Country:US
Practice Address - Phone:972-414-9800
Practice Address - Fax:972-414-9802
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1693213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172445202Medicaid
TX8AA570OtherBCBS
TXV04478Medicare UPIN
TX172445202Medicaid
TX5982470001Medicare NSC
8F5515Medicare PIN