Healthcare Provider Details

I. General information

NPI: 1750465985
Provider Name (Legal Business Name): BENJAMIN DAVID NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST 3RD STREET
DULUTH MN
55805
US

IV. Provider business mailing address

400 EAST 3RD STREET
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3520
  • Fax:
Mailing address:
  • Phone: 218-786-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number47738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: