Healthcare Provider Details

I. General information

NPI: 1386639474
Provider Name (Legal Business Name): CHRISTOPHER LEE NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BUSINESS CENTRE DR SUITE 308
MIRAMAR BEACH FL
32550-6920
US

IV. Provider business mailing address

10301 CHAMPION FARMS DR
LOUISVILLE KY
40241-6129
US

V. Phone/Fax

Practice location:
  • Phone: 850-460-8778
  • Fax: 850-460-8779
Mailing address:
  • Phone: 502-423-1021
  • Fax: 502-423-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number37667
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200201130
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: