MEDICARE: DR. DONALD GENE NORDSTROM M.D.

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	2085R0001X	Radiation Oncology Physician	32028	IA
2	2085R0001X	Radiation Oncology Physician	70913	WI
3	2085R0202X	Diagnostic Radiology Physician	22742	MN
4	2085R0202X	Diagnostic Radiology Physician	83205	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	920005055	OTHER	IA	RR MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	49561	OTHER	IA	IA BLUESHIELD

General Provider Information

NPI Number	:	1225039365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD GENE NORDSTROM M.D.

Provider Business Mailing Address
First Line	:	836 E 65TH ST STE 22
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4493
Country	:	US
Telephone Number	:	912-819-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BUCKWALTER PLACE BLVD STE 150
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5023
Country	:	US
Telephone Number	:	843-836-7120
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/26/2024

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Directions to “ DR. DONALD GENE NORDSTROM M.D.” Practice Location

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