Provider Demographics
NPI:1932579489
Name:JOEL B NILSSON MD PA
Entity type:Organization
Organization Name:JOEL B NILSSON MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:NILSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-288-4423
Mailing Address - Street 1:540 MADISON OAK DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3930
Mailing Address - Country:US
Mailing Address - Phone:210-481-1700
Mailing Address - Fax:210-481-1700
Practice Address - Street 1:110 E BANDERA RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2802
Practice Address - Country:US
Practice Address - Phone:210-481-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352505701Medicaid
TX352505701Medicaid