Provider Demographics
NPI:1992828263
Name:SCOTT NELSON DPM PA
Entity type:Organization
Organization Name:SCOTT NELSON DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-955-7483
Mailing Address - Street 1:3930 NAAMAN SCHOOL ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040
Mailing Address - Country:US
Mailing Address - Phone:972-414-9800
Mailing Address - Fax:972-414-9802
Practice Address - Street 1:3930 NAAMAN SCHOOL ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-414-9800
Practice Address - Fax:972-414-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099PMOtherBCBS
TX185937301Medicaid
TX185937301Medicaid
TX00X816Medicare PIN
5982470001Medicare NSC