Healthcare Provider Details

I. General information

NPI: 1053592162
Provider Name (Legal Business Name): JAMES J NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 NW 83RD ST
GAINESVILLE FL
32606-5603
US

IV. Provider business mailing address

4621 NW 71ST BLVD
GAINESVILLE FL
32606-3947
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-3050
  • Fax: 352-337-2571
Mailing address:
  • Phone: 352-339-6212
  • Fax: 352-337-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: