Individual
KURT NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8288 S BROADWAY AVE, TYLER, TX 75703-5262
(903) 606-7060
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
H6474
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138506424
—
TX
01
—
75-0818167-022
TRICARE
TX
01
—
752616977118
TRICARE
TX
01
—
8DC102
BCBS
TX
Enumeration date
01/29/2007
Last updated
10/13/2014
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