MEDICARE: DR. JEFFREY 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	207P00000X	Emergency Medicine Physician	7654201-1204	UT
2	207Q00000X	Family Medicine Physician	46160-021	WI
3	207Q00000X	Family Medicine Physician	7654201-1204	UT

General Provider Information

NPI Number	:	1619961315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY S NELSON D.O.

Provider Business Mailing Address
First Line	:	8899 S 700 E
Second Line	:	SUITE 250
City	:	SANDY
State	:	UT
Zip	:	84070-1810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8899 S 700 E
Second Line	:	SUITE 155
City	:	SANDY
State	:	UT
Zip	:	84070-1810
Country	:	US
Telephone Number	:	801-413-7775
Fax Number	:	801-878-7507

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/30/2017

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