MEDICARE: DONALD R NELSON 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	207V00000X	Obstetrics & Gynecology Physician	05491	AZ

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	:	1497817878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD R NELSON M.D.

Provider Business Mailing Address
First Line	:	1945 MESQUITE AVE
Second Line	:	STE. A
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5889
Country	:	US
Telephone Number	:	928-855-4128
Fax Number	:	928-855-7539

Provider Business Practice Location Address
First Line	:	1945 MESQUITE AVE
Second Line	:	STE. A
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5889
Country	:	US
Telephone Number	:	928-855-4128
Fax Number	:	928-855-7539

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/08/2008

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