Healthcare Provider Details

I. General information

NPI: 1437259967
Provider Name (Legal Business Name): JAMES B NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 LAKE AVE SUITE 27
FORT WAYNE IN
46805-5428
US

IV. Provider business mailing address

3030 LAKE AVE SUITE 27
FORT WAYNE IN
46805-5428
US

V. Phone/Fax

Practice location:
  • Phone: 260-422-5569
  • Fax: 260-422-6086
Mailing address:
  • Phone: 260-422-5569
  • Fax: 260-422-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01024234A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: