Healthcare Provider Details

I. General information

NPI: 1831334820
Provider Name (Legal Business Name): JEFFREY M. NELSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 N LA CHOLLA BLVD
TUCSON AZ
85741-2306
US

IV. Provider business mailing address

7416 N LA CHOLLA BLVD
TUCSON AZ
85741-2306
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-8400
  • Fax: 520-797-2241
Mailing address:
  • Phone: 520-575-8400
  • Fax: 520-797-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number23419
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number23419
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number23419
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number23419
License Number StateAZ

VIII. Authorized Official

Name: JEFFREY M NELSON
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 520-575-8400