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Organization
NIELSEN UROLOGY
Active
Organization
NIELSEN UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK NIELSEN M.D. (OWNER)
(936) 564-3030
Entity
Organization
Contact information
Practice address
522 RUSSELL BLVD, NACOGDOCHES, TX 75965-1244
(936) 564-3030
Mailing address
522 RUSSELL BLVD, NACOGDOCHES, TX 75965-1244
(936) 564-3030
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T15F
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/14/2007
Last updated
11/14/2007
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