Healthcare Provider Details

I. General information

NPI: 1225016108
Provider Name (Legal Business Name): TROY J. NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 N 3RD AVE
PHOENIX AZ
85013-4360
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-914-1520
  • Fax: 602-914-1521
Mailing address:
  • Phone: 602-470-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: