MEDICARE: JEREMIAH NELSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME 92825	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD-45607	IA
3	208000000X	Pediatrics Physician	35099088	OH
4	2080P0205X	Pediatric Endocrinology Physician	ME0092825	FL
5	2080P0205X	Pediatric Endocrinology Physician	35099088	OH
6	2080P0205X	Pediatric Endocrinology Physician	23921	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	297631	OTHER	FL	AMERIGROUP
2	2438274001	OTHER	FL	CIGNA
3	297105	OTHER	FL	STAYWELL HEALTHY KIDS
4	489063073	OTHER	FL	HUMANA
5	7134730	OTHER	FL	AETNA UNITED
6	16865	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1063494524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH NELSON MD

Provider Business Mailing Address
First Line	:	6355 S BUFFALO DR FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2133
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 N TENAYA WAY STE 320
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0642
Country	:	US
Telephone Number	:	702-862-8226
Fax Number	:	702-862-8227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/18/2023

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Directions to “ JEREMIAH NELSON MD” Practice Location

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