MEDICARE: ALAN S. NELSON D.O.

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	207Q00000X	Family Medicine Physician	O143	ID
2	207Q00000X	Family Medicine Physician	O-143	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215926407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN S. NELSON D.O.

Provider Business Mailing Address
First Line	:	500 W FORT ST # 111
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4599
Country	:	US
Telephone Number	:	208-732-0959
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W FORT ST # 111
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4599
Country	:	US
Telephone Number	:	208-732-0959
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/25/2022

Similar Medicare Providers

1851239024 — IAN CRAIG HOLLAND MD
Practice Location Address:

500 W FORT ST # 111R
BOISE, ID
83702-4599

Practice Phone: 208-422-1000
Practice Fax:

1528160355 — ELIZABETH DANA MORRISON MD
Practice Location Address:

500 W FORT ST # 111
BOISE, ID
83702-4599

Practice Phone: 208-422-1325
Practice Fax: 208-422-1319

1679717946 — JACOB MERLIN HARRIS M.D.
Practice Location Address:

500 W FORT ST
BOISE, ID
83702-4599

Practice Phone: 208-422-1000
Practice Fax: 208-422-1270

1386933513 — LAURA POLY PA
Practice Location Address:

500 W FORT ST # 111
BOISE, ID
83702-4599

Practice Phone: 208-422-1325
Practice Fax: 208-422-1319

1528316700 — KELSEY FIELD BABCOCK PA
Practice Location Address:

500 W FORT ST # 111
BOISE, ID
83702-4599

Practice Phone: 208-422-1000
Practice Fax: 208-422-1319

1053710558 — DR. SUPRIYA PONNAPULA PHARM.D.
Practice Location Address:

500 W FORT ST
BOISE, ID
83702-4599

Practice Phone: 208-422-1000
Practice Fax:

Directions to “ ALAN S. NELSON D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.