Healthcare Provider Details

I. General information

NPI: 1851390504
Provider Name (Legal Business Name): JOEL NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-3688
  • Fax: 812-355-3270
Mailing address:
  • Phone: 812-330-3688
  • Fax: 812-355-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number01035192
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: